What are the treatment options for migraine?

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Dainyal Siddiqui, MD

Internal Medicine

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Manuel Jimenez, MD

Cardiology

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Franz Pierre-Louis, MD

Infectious Disease

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Last updated: June 4, 2025 • View editorial policy

From the Guidelines

Migraine treatment should start with over-the-counter medications like ibuprofen, naproxen, or acetaminophen for mild attacks, and triptans such as sumatriptan for moderate to severe migraines, as recommended by the most recent guideline from the American College of Physicians 1.

Acute Treatment Options

  • Over-the-counter medications: ibuprofen (400-600mg), naproxen (500-550mg), or acetaminophen (1000mg) for mild attacks
  • Triptans: sumatriptan (50-100mg orally, 6mg subcutaneously, or 20mg nasal spray) for moderate to severe migraines
  • Combination therapy: triptan with an NSAID or acetaminophen to improve efficacy ### Preventive Treatment Options
  • Beta-blockers: propranolol (80-240mg daily)
  • Anticonvulsants: topiramate (25-100mg daily)
  • Certain antidepressants: amitriptyline (10-50mg nightly)
  • CGRP antagonists: erenumab (70-140mg monthly injection) ### Non-Medication Approaches
  • Identifying and avoiding triggers: certain foods, stress, irregular sleep
  • Maintaining regular sleep patterns
  • Staying hydrated
  • Practicing stress management techniques: meditation ### Treatment-Resistant Cases
  • Neuromodulation devices
  • Botox injections (155-195 units every 12 weeks) It is essential to consider the individual's specific migraine pattern and severity when selecting a treatment approach, and to counsel patients on the potential risks and benefits of each option, including the risk of medication overuse headache 1.

From the FDA Drug Label

The primary efficacy endpoint for Studies 1 and 2 was the mean change from baseline in the number of monthly migraine headache days over the 6-month treatment period Patients were allowed to use acute headache treatments, including migraine-specific medications (i. e., triptans, ergotamine derivatives), NSAIDs, and acetaminophen during the study EMGALITY 120 mg demonstrated statistically significant improvements for efficacy endpoints compared to placebo over the 6-month period

The treatment options for migraine include:

  • Galcanezumab (EMGALITY): a preventive treatment for episodic or chronic migraine, administered via subcutaneous injection once monthly.
  • Migraine-specific medications: such as triptans (e.g. sumatriptan) and ergotamine derivatives, which can be used as acute treatments for migraine attacks.
  • NSAIDs: nonsteroidal anti-inflammatory drugs, which can be used to treat migraine pain.
  • Acetaminophen: a pain reliever that can be used to treat migraine pain. It is essential to consult a healthcare professional to determine the best treatment plan for individual patients, as the effectiveness and safety of these treatments may vary depending on the patient's specific condition and medical history 2, 3, 4.

From the Research

Migraine Treatment Options

  • Migraine is a highly prevalent neurological disorder with multiple peripheral and central mechanisms, and targeting a single mechanism for treating individual attacks as well as for performing the prophylaxis has been shown to be only partially effective 5
  • The combination of a triptan plus a non-steroidal anti-inflammatory drug (NSAID) has demonstrated better efficacy in treating migraine attacks 5, 6
  • Migraine-specific triptans and migraine-nonspecific nonsteroidal antiinflammatory drugs (NSAIDs) have the best levels of evidence, and are recommended as the first-line medications for acute migraine attacks 6
  • Acute medications can be categorized into "migraine-specific" and "migraine-nonspecific" groups, with triptans and NSAIDs being the most effective options 6

Treatment Guidelines

  • The American Headache Society (AHS) recommends the use of triptans, acetaminophen, and NSAIDs for the acute treatment of migraine 6
  • The Taiwan Headache Society published its treatment guideline for acute migraine attack, which recommends the use of triptans and NSAIDs as first-line medications 6
  • The administration of acute medications should follow the concept of "stratified care", with oral NSAIDs being the first choice for mild to moderate migraine attacks, and oral or nasal spray triptans being recommended for moderate to severe attacks 6

Triptans and NSAIDs

  • Triptans are serotonin (5-HT)(1B/1D) receptor agonists that are generally effective, well tolerated, and safe for the management of migraine 7
  • Seven triptans are available worldwide, with multiple routes of administration, giving doctors and patients a wide choice 7
  • NSAIDs are effective for the management of mild to moderate migraine attacks, and are recommended as the first-line medications for acute migraine attacks 6, 8
  • The combination of a triptan and a NSAID yielded a better efficacy compared with either therapy alone 5, 6

Other Treatment Options

  • Antiemetics can be used as supplement to alleviate nausea and vomiting 6
  • Parenteral steroid and fluid supply are the first choice in treatment of status migrainosus 6
  • Acetaminophen is suitable for mild to moderate migraine attacks and remains the first choice for children and pregnant women 6, 8
  • Opiates are not recommended for acute migraine treatment due to the risk of serious adverse events and medication-overuse headache 6, 8

References

5
Research

The use of combination therapies in the acute management of migraine.

Neuropsychiatric disease and treatment, 2006

6
Research

Medical Treatment Guidelines for Acute Migraine Attacks.

Acta neurologica Taiwanica, 2017

8
Research

Symptomatic treatment of migraine: when to use NSAIDs, triptans, or opiates.

Current treatment options in neurology, 2011

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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.

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