From the Guidelines
Migraine treatment should prioritize acute and preventive approaches, with a focus on individualized decision making based on patient preferences and medical history, as recommended by the American College of Physicians 1.
Acute Treatment Options
For mild episodic migraine headache, consider treating with an NSAID, acetaminophen, or the combination of an NSAID and acetaminophen 1.
- NSAIDs such as aspirin, celecoxib, diclofenac, ibuprofen, or naproxen can be effective.
- Triptans, including almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, or zolmitriptan, are options for moderate to severe migraines.
Preventive Treatment Options
For frequent or severe migraines, preventive medications may be warranted, including CGRP antagonists, beta-blockers, anticonvulsants, and certain antidepressants 1.
- CGRP antagonists, such as rimegepant, ubrogepant, or zavegepant, can be considered for moderate to severe acute episodic migraine headache.
- The ditan lasmiditan can be used 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.
Lifestyle Modifications
Lifestyle modifications are essential, including:
- Staying well hydrated
- Maintaining regular meals
- Securing sufficient and consistent sleep
- Engaging in regular physical activity
- Managing stress with relaxation techniques or mindfulness practices
- Pursuing weight loss for those who are overweight or obese It is crucial to counsel patients to begin treatment of migraine headache as soon as possible after its onset, using combination therapy to improve efficacy, and to be aware of medication overuse headache, a potential complication of migraine treatment 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Migraines
Migraine treatment options can be categorized into acute and preventive measures.
- Acute treatment aims to alleviate symptoms during an attack, while preventive treatment focuses on reducing the frequency and severity of migraine attacks.
Acute Treatment
Acute medications for migraines include:
- Triptans, such as sumatriptan, rizatriptan, and zolmitriptan, which are effective for moderate to severe migraine attacks 2, 3, 4, 5
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, and diclofenac, which are suitable for mild to moderate migraine attacks 2, 3, 4, 5
- Acetaminophen, which is a safe option for mild to moderate migraine attacks, especially during pregnancy 2, 5
- Antiemetic drugs, which can be used to alleviate nausea and vomiting 2, 4, 5
- Dihydroergotamine (DHE), which is suitable for selected patients 5
Preventive Treatment
Preventive measures for migraines include:
- Lifestyle changes, such as avoiding migraine triggers, maintaining regular sleep, eating, and work habits 3
- Drug therapy, including beta-blockers, calcium channel blockers, tricyclic antidepressants, and anticonvulsants, which must be individualized based on efficacy, potential adverse effects, and co-existing medical conditions 3
Treatment Strategies
Treatment strategies for migraines can be organized into four categories:
- The acetaminophen-NSAID strategy, suitable for patients with mild to moderate attacks 5
- The triptan strategy, suitable for patients with severe attacks or those who do not respond well to NSAIDs 5
- The refractory migraine strategy, which includes using triptans and NSAIDs simultaneously, DHE, and rescue medications for patients who do not respond well to initial treatments 5
- Strategies for patients with contraindications to vasoconstricting drugs, which include using NSAIDs, combination analgesics, and dopamine antagonists 5
Patient Preferences
Patients prefer treatments that are rapid, effective, and convenient, with oral administration being the most preferred route 6. Tablets that dissolve rapidly on the tongue without requiring extra fluid intake are a popular alternative to conventional tablets, allowing for discreet and early treatment of migraine attacks 6.