What is a recommended first-line abortive therapy for migraine in a healthy female?

From the Guidelines

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-600 mg) or naproxen sodium (500-550 mg) are recommended as first-line abortive therapies for migraine in a healthy female. These medications should be taken at the first sign of migraine symptoms and can be repeated every 6-8 hours as needed, not exceeding the maximum daily dose (ibuprofen 3200 mg/day; naproxen 1500 mg/day) 1. For optimal effectiveness, take with food to minimize gastrointestinal side effects. It is essential to limit the use of acute therapy to no more than two times per week to guard against medication-overuse headache (or drug-induced headache) 1. If NSAIDs alone are insufficient, acetaminophen (1000 mg) can be added, or combination medications containing caffeine may be considered. NSAIDs work by inhibiting cyclooxygenase enzymes, reducing prostaglandin production which decreases inflammation and pain signaling in migraine pathways. They also help reduce the neurogenic inflammation associated with migraine attacks. If these over-the-counter options fail to provide adequate relief, prescription triptans like sumatriptan would be the next step, but require consultation with a healthcare provider.

Some key considerations in the management of migraine include:

• The choice of treatment should be based on the frequency and severity of attacks, the presence and degree of temporary disability, and the profile of associated symptoms, such as nausea and vomiting 1.
• The patient's history of, response to, and tolerance for specific medications must also be considered.
• Coexisting conditions, such as heart disease, pregnancy, and uncontrolled hypertension, may limit treatment choices 1.
• A cooperative arrangement between provider and patient may extend to the use of rescue medication in appropriate situations, such as a severe migraine attack that is not responding to other treatments 1.

From the FDA Drug Label

The provided drug labels do not directly address the question of a recommended first-line abortive therapy for migraine in a healthy female.

The FDA drug label does not answer the question.

From the Research

Abortive Therapy for Migraine in Healthy Females

• The recommended first-line abortive therapy for migraine in healthy females includes triptans, which are serotonin 5-HT1B/1D receptor agonists 2, 3, 4, 5, 6.
• Sumatriptan, a triptan, is effective in relieving pain, nausea, photophobia, phonophobia, and functional disability, but is associated with increased adverse events 2, 5.
• Eletriptan consistently yielded the highest treatment effect estimates among triptans, and was statistically significantly superior to sumatriptan, almotriptan, naratriptan, and frovatriptan for at least one of the two-hour endpoints 3.
• Almotriptan and sumatriptan are similarly effective in the abortive treatment of moderate or severe migraine headache, and are also similarly well tolerated and safe 4.
• Subcutaneous sumatriptan is effective as an abortive treatment for acute migraine attacks, quickly relieving pain, nausea, photophobia, phonophobia, and functional disability, but is associated with increased adverse events 5.
• The different triptans show only minor differences in efficacy, headache recurrence, and adverse effects, allowing for a more specific treatment of individual migraine characteristics 6.

Treatment Options

• Oral sumatriptan is effective as an abortive treatment for migraine attacks, relieving pain, nausea, photophobia, phonophobia, and functional disability 2.
• Subcutaneous sumatriptan may be preferable to oral for individuals experiencing nausea and/or vomiting 5.
• Other triptans, such as almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, and zolmitriptan, are also effective in treating migraine attacks 3, 4, 6.
• Analgesics like aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) are effective in treating migraine attacks, but may have inferior efficacy compared to triptans 6.