From the Guidelines
Migraine treatment should prioritize acute and preventive approaches, with NSAIDs such as ibuprofen (400-600mg) or acetaminophen (1000mg) as first-line therapy for mild attacks, and triptans like sumatriptan (50-100mg orally) for moderate to severe migraines, as evidenced by studies 1.
Acute Treatment
For acute treatment, the following options are available:
- Over-the-counter pain relievers like ibuprofen (400-600mg) or acetaminophen (1000mg) for mild attacks
- Triptans such as sumatriptan (50-100mg orally) for moderate to severe migraines
- Non-oral routes of administration, such as subcutaneous sumatriptan, for patients with nausea or vomiting
Preventive Treatment
For frequent or severe migraines, preventive medications may be necessary, including:
- Beta-blockers (propranolol 80-240mg daily)
- Anticonvulsants (topiramate 25-100mg daily)
- Certain antidepressants (amitriptyline 10-50mg nightly)
- CGRP antagonists (erenumab 70-140mg monthly injection)
Non-Medication Approaches
Non-medication 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
- Resting in a dark, quiet room during an attack Some patients may also benefit from neuromodulation devices or Botox injections for chronic migraines, as supported by studies 1. Treatment should be individualized based on migraine frequency, severity, and other health conditions, with adjustments made as needed for optimal control.
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, doses of 25,50, and 100 mg were compared with placebo in the treatment of migraine attacks.
The treatment for migraines is sumatriptan tablets at doses of 25, 50, or 100 mg.
- The medication is used for the acute treatment of migraine headaches.
- Patients can take a second dose of sumatriptan tablets or other medication 4 to 24 hours after the initial treatment for recurrent headache.
- Acetaminophen can be offered to patients 2 hours after initial treatment if the migraine pain has not improved or has worsened 2.
From the Research
Treatment Options for Migraines
The treatment for migraines can be categorized into acute and prophylactic treatments.
- Acute treatments are used to relieve symptoms during a migraine attack, while prophylactic treatments are used to prevent migraine attacks from occurring.
Acute Treatment
Acute treatments for migraines include:
- Analgesics such as aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) which are effective in treating migraine attacks 3, 4, 5, 6
- Triptans, such as almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan, which are highly effective in improving headache, nausea, photo- and phonophobia 3, 4, 7, 5
- Anti-emetics and ergot alkaloids, which are recommended for use as second- or third-line therapy for select patients or for those with refractory migraine 5
Prophylactic Treatment
Prophylactic treatments for migraines include:
- Beta-blockers such as metoprolol and propranolol, which have proven efficacy in preventing migraine attacks 3, 4
- Calcium channel blockers such as flunarizine, which have proven efficacy in preventing migraine attacks 3, 4
- Anti-epileptic drugs such as valproic acid, gabapentin, and topiramate, which have been evaluated for the prophylaxis of migraine 3, 4
- Botulinum toxin, which is under investigation for the prophylaxis of migraine 3, 4
Considerations for Treatment
When selecting a treatment for migraines, considerations should include: