What are the treatment guidelines for migraine headaches?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
DS

Dainyal Siddiqui, MD

Internal Medicine

MJ

Manuel Jimenez, MD

Cardiology

FP

Franz Pierre-Louis, MD

Infectious Disease

Article Review Status
Submitted
Under Review
Approved

Last updated: May 22, 2025 • View editorial policy

From the Guidelines

Migraine treatment should start with a triptan and an NSAID or acetaminophen for acute episodic migraine headache in outpatient settings, as recommended by the American College of Physicians 1.

Key Recommendations

  • Consider using the ditan lasmiditan to treat moderate to severe acute episodic migraine headache in nonpregnant outpatient adults who do not tolerate or have inadequate response to all other pharmacologic treatments included in this guideline 1.
  • Do not use opioids or butalbital for the treatment of acute episodic migraine 1.
  • Consider using a nonoral triptan and an antiemetic in people having severe nausea or vomiting 1.
  • Counsel patients to begin treatment of migraine headache as soon as possible after its onset, using combination therapy (such as a triptan with an NSAID or acetaminophen) to improve efficacy 1.

Lifestyle Modifications

  • Highlight the importance of lifestyle modifications with patients, including: + Staying well hydrated + Maintaining regular meals + Securing sufficient and consistent sleep + Engaging in regular physical activity (preferably moderate to intense aerobic exercise) + Managing stress with relaxation techniques or mindfulness practices + Pursuing weight loss for those who are overweight or obese 1.

Preventive Medications

  • If the episodic migraine occurs frequently or treatment does not provide an adequate response, the addition of preventive medications may be warranted 1.
  • Patients should be aware of medication overuse headache, which is a potential complication of migraine treatment, and the threshold for medication overuse headache varies by treatment 1.

From the FDA Drug Label

The efficacy of rizatriptan benzoate orally disintegrating tablets in pediatric patients 6 to 17 years was evaluated in a multicenter, randomized, double-blind, placebo-controlled, parallel group clinical trial (Study 7) The percentage of patients achieving the primary efficacy endpoint of no headache pain at 2 hours after treatment was significantly greater in patients who received rizatriptan benzoate orally disintegrating tablets, compared with those who received placebo (33% vs. 24%) The efficacy of sumatriptan tablets in the acute treatment of migraine headaches was demonstrated in 3, randomized, double-blind, placebo-controlled trials. In all 3 trials, the percentage of patients achieving headache response 2 and 4 hours after treatment was significantly greater among patients receiving sumatriptan tablets at all doses compared with those who received placebo

The migraine treatment guideline for patients can be summarized as follows:

  • Rizatriptan is effective in treating migraine headaches in patients, with a significant percentage of patients achieving no headache pain at 2 hours after treatment 2.
  • Sumatriptan is also effective in treating migraine headaches, with a significant percentage of patients achieving headache response at 2 and 4 hours after treatment 3.
  • The treatment guidelines may vary depending on the patient's age, with rizatriptan being effective in pediatric patients 6 to 17 years old 2.
  • The choice of treatment may depend on the individual patient's needs and medical history, and should be made under the guidance of a healthcare professional.
  • Key points to consider when treating migraine headaches include:
    • The use of rizatriptan or sumatriptan as a first-line treatment for acute migraine headaches
    • The importance of individualizing treatment based on the patient's age, medical history, and response to treatment
    • The need for patients to follow up with their healthcare provider to assess the effectiveness of treatment and make any necessary adjustments.

From the Research

Migraine Treatment Guidelines

  • Migraine treatment guidelines recommend avoiding known migraine headache triggers and adhering to healthy lifestyle behaviors 4
  • A cohort study found that many triggers, such as caffeine, alcohol, and chocolate, can actually decrease the probability of migraine attacks in some individuals 4
  • The study also found that people who were more compliant with healthy behaviors, such as keeping good hydration and regular meals, were significantly older and had been diagnosed with migraine disease for a longer period 4

Acute Treatments for Episodic Migraine

  • A systematic review and meta-analysis found that several acute treatments for episodic migraine, including triptans, nonsteroidal anti-inflammatory drugs, and calcitonin gene-related peptide receptor antagonists, were associated with improved pain and function 5
  • The review also found that nonpharmacologic treatments, such as remote electrical neuromodulation and transcranial magnetic stimulation, were significantly associated with improved pain 5

Role of Gepants in Migraine Treatment

  • Gepants, calcitonin-gene-related peptide receptor antagonists, have shown efficacy and safety in recent clinical trials for the acute and preventive treatment of migraine 6
  • Gepants may have a particular benefit for patients with medication overuse headache and those with comorbid cardiovascular diseases 6

Comparative Efficacy of Oral CGRP Antagonists

  • A meta-analysis found that oral CGRP antagonists were significantly more effective than placebo in treating acute migraine, but less effective than triptans 7
  • The meta-analysis suggested that CGRP antagonists may be a useful treatment option for patients with acute migraine, particularly those with co-existing cardiovascular diseases 7

Lifestyle Factors and Migraine

  • Lifestyle factors, such as stress, sleep, diet, and physical activity, can play a role in migraine attack occurrence 8
  • Behaviour change interventions that address overlapping lifestyle factors may be an effective way to manage migraine 8

References

8
Research

Lifestyle factors and migraine.

The Lancet. Neurology, 2022

Related Questions

Is phentermine (an appetite suppressant) effective for treating migraines?
What are the symptoms of migraines (episodic headaches)?
Can rebound migraine occur after stopping Qulipta (atogepant)?
What is the treatment approach for patients experiencing migraines?
Can Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) be used to treat headaches in acute Transient Ischemic Attack (TIA)?
What is a junctional rhythm?
What is the diagnosis for a 65-year-old female with normal left ventricular systolic function, grade II diastolic dysfunction, mild mitral valve stenosis, trace mitral valve regurgitation, and mild pulmonary hypertension?
What is the revised 10-year absolute fracture risk for a patient with known multiple vertebral compression fractures, given an initial moderate risk based on age, gender, and femoral neck bone mineral density (BMD) readings?
What is the diagnosis and treatment for Ventilator-Associated Pneumonia (VAP)?
What are the diagnosis, causes, and management of junctional rhythm bradycardia (abnormally slow heart rate originating from the atrioventricular (AV) junction)?
What is the likely cause of a 19-year-old female's vaginal itching, irritation, and passage of a tissue-like mass, given her history of unprotected sexual encounter in April and current use of Depo (medroxyprogesterone) injection for contraception?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Ask a new Question. Chat with the Guidelines