From the Guidelines
For the treatment of episodic migraines, consider using a combination therapy of a triptan and an NSAID or acetaminophen as the first line of treatment, and reserve lasmiditan for those who do not tolerate or have inadequate response to other pharmacologic treatments. When managing acute episodic migraine headache in nonpregnant outpatient adults, it is essential to consider the severity of the migraine and the patient's response to initial treatments 1. For moderate to severe acute episodic migraine headache, the use of a triptan with an NSAID or acetaminophen is recommended as the initial pharmacologic treatment approach. Some key points to consider in the management of episodic migraines include:
- Avoiding the use of opioids or butalbital for the treatment of acute episodic migraine due to their potential for dependence and other adverse effects 1.
- Considering the use of a nonoral triptan and an antiemetic in patients experiencing severe nausea or vomiting, as this can improve the efficacy of treatment and reduce the burden of symptoms 1.
- Discussing the potential adverse effects of pharmacologic treatments during pregnancy and lactation with patients of childbearing potential, as this can impact treatment choices and patient safety 1.
- Counseling patients to begin treatment of migraine headache as soon as possible after its onset, using combination therapy to improve efficacy, and highlighting the importance of lifestyle modifications such as staying well hydrated, maintaining regular meals, and managing stress 1. In cases where episodic migraines occur frequently or treatment does not provide an adequate response, the addition of preventive medications may be warranted, and patients should be aware of the potential for medication overuse headache, which can be a complication of migraine treatment 1.
From the FDA Drug Label
The efficacy of eletriptan hydrobromide in the acute treatment of migraines was evaluated in eight randomized, double-blind placebo-controlled studies. In all eight studies, randomized patients treated their headaches as outpatients The percentage of patients achieving headache response 2 hours after treatment was significantly greater among patients receiving eletriptan hydrobromide at all doses compared to those who received placebo.
The treatment options for episodic migraines include eletriptan hydrobromide.
- The recommended dose is 20 mg, 40 mg, or 80 mg.
- Eletriptan hydrobromide has been shown to be effective in reducing headache severity from moderate or severe pain to mild or no pain within 2 hours after dosing 2.
- Patients may take a second dose of eletriptan hydrobromide or other medication 2 to 24 hours after the initial treatment for both persistent and recurrent headaches.
From the Research
Treatment Options for Episodic Migraines
The treatment options for episodic migraines include:
- Abortive medications, such as triptans, to relieve pain and associated symptoms during an attack 3, 4, 5
- Antiemetics to relieve nausea and vomiting 4, 6
- Analgesics, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), to relieve pain 4, 6, 7
- Ergot alkaloids, such as ergotamine and dihydroergotamine, to relieve pain and associated symptoms 4, 6
Pharmacological Approaches
Pharmacological approaches to migraine treatment include:
- Sumatriptan, a 5HT1-like receptor agonist, which is effective in reducing headache and associated symptoms 3, 5
- Other triptans, such as almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, and zolmitriptan, which have minor differences in efficacy, headache recurrence, and adverse effects 6, 7
- Beta-blockers, such as metoprolol and propranolol, which are effective in migraine prophylaxis 6, 7
- Calcium channel blockers, such as flunarizine, which are effective in migraine prophylaxis 6, 7
Treatment Principles
Treatment principles for episodic migraines include:
- Taking medication early in an attack to relieve pain and associated symptoms 4
- Using a stratified treatment approach to individualize therapy based on the pattern and severity of attacks 4
- Considering the pharmacologic properties, potential adverse effects, cost, and routes of administration of different medications to choose the most effective treatment option 4