What are the treatment guidelines for migraine?

From the Guidelines

The most effective treatment for migraine involves a combination of acute and preventive strategies, with first-line options including triptans and NSAIDs or acetaminophen, as recommended by the American College of Physicians in 2025 1. Migraine treatment typically involves both acute and preventive strategies.

• For acute treatment, first-line options include:
  • Triptans such as sumatriptan (50-100mg orally, 6mg subcutaneously, or 20mg intranasally)
  • NSAIDs like ibuprofen (400-600mg) or naproxen (500-550mg)
  • Acetaminophen (1000mg) for mild to moderate attacks
• For nausea, antiemetics like metoclopramide (10mg) or prochlorperazine (10mg) can be added.
• Preventive treatment is recommended for patients with frequent migraines (≥4 monthly), significant disability, or poor response to acute treatments.
• First-line preventives include beta-blockers, antiepileptics, and certain antidepressants.
• Non-pharmacological approaches like trigger avoidance, regular sleep, stress management, and lifestyle modifications are important components of comprehensive migraine management.
• The American College of Physicians recommends considering the use of 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.
• Opioids or butalbital should not be used for the treatment of acute episodic migraine 1.
• Patients should be aware of medication overuse headache, which is a potential complication of migraine treatment, and the importance of lifestyle modifications, including staying well hydrated, maintaining regular meals, securing sufficient and consistent sleep, engaging in regular physical activity, managing stress, and pursuing weight loss if applicable 1.

From the FDA Drug Label

AIMOVIG is indicated for the preventive treatment of migraine in adults. The recommended dosage of AIMOVIG is 70 mg injected subcutaneously once monthly. Some patients may benefit from a dosage of 140 mg injected subcutaneously once monthly. Sumatriptan tablets are used for the acute treatment of migraine headaches.

The treatment guidelines for migraine include:

• Preventive treatment: AIMOVIG (erenumab) 70 mg or 140 mg injected subcutaneously once monthly 2
• Acute treatment: Sumatriptan tablets 25 mg, 50 mg, or 100 mg orally 3 Key points:
• AIMOVIG is for preventive treatment of migraine in adults
• Sumatriptan tablets are for acute treatment of migraine headaches
• Dosage and administration instructions should be followed carefully 2, 3

From the Research

Treatment Guidelines for Migraine

The treatment guidelines for migraine involve a variety of options, including acute treatments and preventive measures.

• Acute treatments are used to relieve symptoms during a migraine attack, while preventive measures are used to reduce the frequency and severity of attacks.

Acute Treatment Options

Acute treatment options for migraine include:

• Triptans, such as sumatriptan, which are considered first-line treatments for moderate to severe migraine attacks 4, 5, 6
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, which are effective for mild to moderate migraine attacks 4, 5, 6
• Ergot derivatives, such as ergotamine, which are effective for moderate to severe migraine attacks 4, 5
• Antiemetics, such as prochlorperazine, which can be used to alleviate nausea and vomiting 6
• Combination therapies, such as a triptan and a NSAID, which can be more effective than either therapy alone 6

Preventive Treatment Options

Preventive treatment options for migraine include:

• Beta-blockers, such as propranolol, which are effective for reducing the frequency and severity of migraine attacks 5, 7
• Antiepileptic drugs, such as topiramate and divalproex sodium, which are effective for reducing the frequency and severity of migraine attacks 5, 7
• Calcium channel blockers, which may be effective for reducing the frequency and severity of migraine attacks, but have limited evidence 7
• Botulinum toxin A, which is being studied as a potential preventive treatment for migraine 8

Treatment Considerations

When selecting a treatment for migraine, it is essential to consider the individual patient's needs and medical history.

• Patients with certain medical conditions, such as cardiovascular disease, may need to avoid certain treatments, such as triptans 4
• Patients who are pregnant or breastfeeding may need to avoid certain treatments, such as NSAIDs and triptans 4, 6
• Patients who experience medication-overuse headache may need to limit their use of acute treatments to a maximum of ten days a month 6