What are the recommended treatments for migraine management?

From the Guidelines

Migraine management should prioritize a combination of acute treatments, such as triptans and NSAIDs, and preventive strategies, including lifestyle modifications and pharmacologic treatments, to reduce frequency and severity, as recommended by the most recent guideline from the American College of Physicians 1.

Acute Treatment

For acute treatment, first-line options include:

• Triptans, such as sumatriptan or rizatriptan
• NSAIDs, such as ibuprofen or naproxen
• Combination therapy with antiemetics like metoclopramide for severe or refractory migraines These should be taken early in an attack for maximum effectiveness, and patients should be counseled to begin treatment as soon as possible after onset 1.

Preventive Treatment

Preventive treatment is recommended for patients with frequent migraines (≥4 monthly) or significant disability. Effective preventive medications include:

• Beta-blockers, such as propranolol
• Anticonvulsants, such as topiramate
• Certain antidepressants, such as amitriptyline
• CGRP antagonists, such as erenumab

Lifestyle Modifications

Lifestyle modifications are also crucial, including:

• Regular sleep patterns
• Stress management
• Consistent meals
• Adequate hydration
• Identifying personal triggers These modifications can help reduce the frequency and severity of migraines, and should be discussed with patients as part of a comprehensive management plan 1.

Important Considerations

• Medication overuse headache is a potential complication of migraine treatment, and patients should be aware of the risks and symptoms 1.
• The importance of lifestyle modifications should be highlighted with patients, and they should be encouraged to make changes to reduce their migraine frequency and severity 1.
• Patients should be prescribed less costly recommended medications, and the importance of cost-effectiveness should be considered in treatment decisions 1.

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. In all 3 trials, the percentage of patients achieving headache response 2 and 4 hours after treatment was significantly greater among patients receiving sumatriptan tablets at all doses compared with those who received placebo

The recommended treatment for migraine management is sumatriptan tablets at doses of 25, 50, or 100 mg. These doses have been shown to be effective in achieving headache response within 2 and 4 hours after treatment. Key points include:

• Sumatriptan tablets are effective for the acute treatment of migraine headaches
• Doses of 25, 50, and 100 mg are effective, with no significant differences between the 50 and 100 mg dose groups
• Patients may take a second dose or other medication for migraine over the 24 hours following the initial dose of study treatment 2

From the Research

Migraine Management Treatments

Migraine management involves various treatments, including:

• Abortive medications to relieve symptoms during an attack
• Preventive medications to reduce frequency and severity of attacks
• Lifestyle modifications to avoid triggers

Abortive Treatments

Abortive treatments for migraine include:

• Triptans, such as sumatriptan 3, which are effective in relieving pain, nausea, photophobia, and phonophobia
• Nonsteroidal anti-inflammatory drugs (NSAIDs) 4, which are recommended for mild to moderate migraine attacks
• Dihydroergotamine 4, which is a migraine-specific agent for severe attacks

Preventive Treatments

Preventive treatments for migraine include:

• Beta-blockers, such as propranolol and timolol 5, 6, 7, which are effective in reducing frequency and severity of attacks
• Anti-epileptic drugs, such as topiramate and divalproex sodium 5, 6, 7, which are effective in reducing frequency and severity of attacks
• Antidepressants, such as amitriptyline 5, 6, 7, which are effective in reducing frequency and severity of attacks

Non-Pharmacological Treatments

Non-pharmacological treatments for migraine include:

• Relaxation techniques 7
• Bio-feedback 7
• Cognitive behavioral therapy 7
• Acupuncture 7

Treatment Considerations

Treatment decisions should consider:

• Contraindications 6
• Effectiveness of alternatives 6
• Potential side effects 6
• Patient preferences and lifestyle 6