What are the recommended treatments for migraines?

From the Guidelines

Migraine treatment should prioritize a combination of a triptan and an NSAID or acetaminophen for acute episodes, with consideration of preventive medications for frequent or severe cases. According to the most recent guideline from the American College of Physicians 1, this approach is recommended for the treatment of acute episodic migraine headache in outpatient settings. The guideline suggests considering the use of a ditan like lasmiditan for 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 the guideline.

For acute treatment, the following options are recommended:

• Over-the-counter medications like ibuprofen (400-600mg), naproxen (500-550mg), or acetaminophen (1000mg) for mild attacks
• Triptans such as sumatriptan (50-100mg orally, 6mg subcutaneously, or 20mg nasal spray) for moderate to severe migraines, to be taken early in an attack
• A nonoral triptan and an antiemetic for people having severe nausea or vomiting

Preventive medications may be considered for frequent or severe migraines, including:

• Beta-blockers (propranolol 80-240mg daily)
• Anticonvulsants (topiramate 50-200mg daily)
• Certain antidepressants (amitriptyline 10-150mg daily)
• CGRP antagonists (monthly injections)

Non-pharmacological approaches are also important, including:

• Identifying and avoiding triggers (certain foods, stress, irregular sleep)
• Maintaining regular sleep patterns
• Staying hydrated
• Practicing stress management techniques like meditation
• Creating a migraine diary to track triggers and treatment effectiveness to optimize the personal treatment plan 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION 2. 1 Dosing Information The recommended dose of sumatriptan tablets is 25 mg, 50 mg, or 100 mg. The efficacy of sumatriptan tablets in the acute treatment of migraine headaches was demonstrated in 3, randomized, double-blind, placebo-controlled trials.

The recommended treatments for migraines include sumatriptan tablets in doses of 25 mg, 50 mg, or 100 mg. The dosage may be repeated after at least 2 hours if the migraine has not resolved, with a maximum daily dose of 200 mg in a 24-hour period 2. The efficacy of sumatriptan tablets has been demonstrated in 3 clinical trials, showing a significant percentage of patients achieving headache response 2 and 4 hours after treatment 2.

• Key points:
  • Dosing: 25 mg, 50 mg, or 100 mg
  • Repeat dose: at least 2 hours after the first dose
  • Maximum daily dose: 200 mg in a 24-hour period
  • Efficacy: demonstrated in 3 clinical trials with significant headache response at 2 and 4 hours after treatment 2, 2

From the Research

Migraine Treatment Options

Migraine is a common neurovascular disorder characterized by recurrent episodes of disabling headache, autonomic nervous system dysfunction, and, in some patients, neurological aura symptoms. The recommended treatments for migraines include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) for mild to moderate migraine attacks 3
• Triptans, such as sumatriptan, for moderate to severe migraine attacks 4, 3, 5
• Combination therapies, such as sumatriptan plus naproxen, for acute migraine attacks 6
• Antiemetics and ergot alkaloids for select patients or for those with refractory migraine 7

Treatment Strategies

The treatment of migraine headaches can be individualized based on the pattern and severity of attacks. Some key principles include:

• Taking medication early in an attack 6
• Using a stratified treatment approach, where patients with less frequent episodic migraine use acute agents at the earliest signs of headache, and those with frequent headache limit acute treatments to only the most disabling episodes 3
• Considering rescue or back-up therapy for patients who do not respond to initial treatment 3

Efficacy and Tolerability of Treatments

The efficacy and tolerability of migraine treatments have been studied in several clinical trials. For example:

• Sumatriptan has been shown to be an effective drug for the treatment of a single acute attack of migraine, with a number-needed-to-treat (NNT) of 5.1 for pain-free response at 2 hours 4
• The combination of sumatriptan plus naproxen has been shown to be effective in the acute treatment of migraine headaches, with a NNT of 3.1 for pain-free response at 2 hours when baseline pain is mild 6
• Adverse events are more common with triptans, such as sumatriptan, than with NSAIDs, such as naproxen 4, 6