From the Guidelines
The most effective treatment for acute migraine management is a combination of a triptan and an NSAID or acetaminophen, which should be initiated as soon as possible after the onset of symptoms. According to the American College of Physicians guideline published in 2025 1, this approach can improve efficacy and provide better relief for patients. The guideline recommends considering the use of a triptan, such as sumatriptan, and an NSAID, such as ibuprofen, or acetaminophen for the treatment of acute episodic migraine headache in outpatient settings.
Some key points to consider in the management of acute migraine include:
- The use of opioids or butalbital is not recommended for the treatment of acute episodic migraine due to the risk of medication overuse headache and other adverse effects 1.
- For patients with severe nausea or vomiting, a nonoral triptan and an antiemetic may be considered to enhance treatment effectiveness 1.
- The ditan lasmiditan may be considered for the treatment of moderate to severe acute episodic migraine headache in nonpregnant outpatient adults who do not tolerate or have an inadequate response to other pharmacologic treatments 1.
- Patients should be counseled to begin treatment as soon as possible after the onset of symptoms and to be aware of the potential for medication overuse headache, which can occur with frequent use of acute medications 1.
In addition to pharmacologic treatments, lifestyle modifications can play an important role in the management of acute migraine. These include:
- Staying well hydrated
- Maintaining regular meals
- Securing sufficient and consistent sleep
- Engaging in regular physical activity, such as moderate to intense aerobic exercise
- Managing stress with relaxation techniques or mindfulness practices
- Pursuing weight loss for those who are overweight or obese
- Exploring modifiable migraine triggers or contributing factors during a detailed history 1.
From the FDA Drug Label
Sumatriptan tablets are indicated for the acute treatment of migraine with or without aura in adults. The efficacy of sumatriptan tablets in the acute treatment of migraine headaches was demonstrated in 3, randomized, double-blind, placebo-controlled trials. The treatment options for acute migraine management include sumatriptan tablets.
- The dosage of sumatriptan tablets for acute migraine treatment is 25 mg, 50 mg, or 100 mg.
- Additional treatments such as acetaminophen may be allowed 4 to 24 hours after the initial treatment for recurrent headache or as rescue. The use of sumatriptan tablets for acute migraine treatment should be guided by the principle of using the lowest effective dose and reconsidering the diagnosis of migraine if there is no response to the first migraine attack treated with sumatriptan tablets 2 2.
From the Research
Treatment Options for Acute Migraine Management
The management of acute migraine involves various treatment options, including:
- Analgesics like aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) which are effective in treating migraine attacks 3, 4, 5, 6
- Serotonin (5-HT)1B/D-agonists, also known as triptans, which are highly effective in improving headache, nausea, photo- and phonophobia 3, 4, 5
- Ergotamine or dihydroergotamine, although their efficacy is inferior compared to triptans 3, 4, 7
- Anti-emetics like metoclopramide, domperidone, and prochlorperazine 5, 7
- Non-opioid combination analgesics, such as acetaminophen, ASA, and caffeine 5
Acute Migraine Treatment Strategies
Acute migraine treatment can be organized into different strategies, including:
- A strategy for attacks of mild to moderate severity using acetaminophen and/or NSAIDs 5
- A triptan strategy for patients with severe attacks or for attacks not responding to the first strategy 5
- A refractory attack strategy 5
- A strategy for patients with contraindications to vasoconstricting drugs 5
Considerations for Choosing an Acute Migraine Medication
When choosing an acute migraine medication, several clinical features should be considered, including: