What is the best urgent care treatment for migraine?

From the Guidelines

The best urgent care treatment for migraines typically involves a combination of medications to address pain and associated symptoms, with triptans such as sumatriptan or rizatriptan being first-line treatments. For acute migraine relief, these medications work by constricting blood vessels and blocking pain pathways.

• NSAIDs like ibuprofen (400-600mg) or naproxen (500-550mg) can also be effective, especially when taken early in an attack.
• For severe migraines, urgent care providers might administer intravenous medications such as ketorolac (30mg IV), metoclopramide (10mg IV) for both pain and nausea, or dexamethasone (10mg IV) to prevent recurrence.
• Antiemetics like ondansetron (4mg) may be added if nausea is prominent.
• Fluid therapy with IV normal saline can help with associated dehydration. According to 1, the combination of isometheptene, acetaminophen, and dichloralphenazone has been shown to be effective in the treatment of milder migraine headaches.
• Patients should rest in a dark, quiet room during treatment, as light and noise can worsen symptoms. These treatments work by reducing inflammation, altering blood flow patterns in the brain, and blocking pain transmission pathways involved in migraine pathophysiology.
• It is essential to note that the efficacy of these treatments may vary depending on the individual patient and the severity of their migraine symptoms. As stated in 1, nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line therapy for most migraine sufferers, with the most consistent evidence existing for aspirin, ibuprofen, naproxen sodium, tolfenamic acid, and the combination agent acetaminophen plus aspirin plus caffeine.
• In patients whose migraine attack has not responded to NSAIDs, migraine-specific agents (triptans, DHE) should be used, with good evidence for the following triptans: oral naratriptan, rizatriptan, and zolmitriptan; oral and subcutaneous sumatriptan; and DHE nasal spray.
• For optimal results, treatment should begin as early as possible after migraine onset.

From the FDA Drug Label

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 best urgent care treatment for migraine is sumatriptan, as it has been shown to be effective in the acute treatment of migraine headaches.

• Key benefits:
  • Significant reduction in headache severity
  • Improvement in associated symptoms such as nausea, photophobia, and phonophobia
  • Rapid onset of action, with effects seen as early as 2 hours after treatment
• Important considerations:
  • Sumatriptan should be used with caution in patients with certain medical conditions, such as coronary artery disease, uncontrolled hypertension, and epilepsy
  • Patients should be evaluated for the presence of CAD or a predisposition to Prinzmetal variant angina before receiving additional doses of sumatriptan
  • Sumatriptan should not be used in combination with certain medications, such as MAO-A inhibitors and ergot-containing drugs 2 3 3

From the Research

Urgent Care Treatment for Migraine

The best urgent care treatment for migraine can vary depending on the severity and frequency of the attacks.

• For mild to moderate migraines, over-the-counter medications such as acetaminophen, ibuprofen, naproxen, and aspirin are considered first-line treatments 4.
• These medications have shown strong efficacy when used as first-line treatments for mild-to-moderate migraine attacks and have fewer and less severe adverse effects compared to prescription medications 4.
• For moderate to severe migraines, triptans are considered first-line treatments 5, 6.
• Triptans, such as sumatriptan, zolmitriptan, and rizatriptan, are effective in treating moderate or severe migraine and can provide rapid relief from headache and sustained duration of effect 5.
• Combining triptans with nonsteroidal anti-inflammatory drugs (NSAIDs) has demonstrated better efficacy in treating migraine attacks 7.
• The fixed combination of sumatriptan and naproxen sodium has been shown to offer improved 2-hour and 24-hour benefits over monotherapy 7.
• In some cases, the addition of dexamethasone to the combination of a triptan and an NSAID may be useful in reducing migraine recurrence 8.

Treatment Strategies

• Taking medication early in an attack and using a stratified treatment approach can help ensure that migraine treatment is cost-effective 6.
• The pharmacologic properties, potential adverse effects, cost, and routes of administration of medications vary widely, allowing therapy to be individualized based on the pattern and severity of attacks 6.
• Other medications such as dihydroergotamine and antiemetics may be recommended for use as second- or third-line therapy for select patients or for those with refractory migraine 6.