From the Guidelines
Migraine therapy should prioritize preventive treatment with beta blockers, topiramate, or candesartan as first-line medications, and consider CGRP monoclonal antibodies as third-line medications, as recommended by the most recent and highest quality study 1. For acute migraines, first-line medications include NSAIDs like ibuprofen (400-600mg) or naproxen (500-550mg), or triptans such as sumatriptan (50-100mg orally, 6mg subcutaneously, or 20mg intranasally) 1. Key considerations for treatment include:
- Preventive treatment should be considered in patients who are adversely affected by migraine on ≥2 days per month despite optimized acute treatment 1.
- Beta blockers, topiramate, or candesartan are recommended as first-line medications for preventive treatment 1.
- CGRP monoclonal antibodies should be considered as third-line medications for preventive treatment 1.
- Non-pharmacological approaches like biofeedback, cognitive behavioral therapy, and acupuncture can complement medication therapy 1.
- Lifestyle modifications, including regular sleep patterns, stress management, avoiding known triggers, and staying hydrated, are crucial for reducing frequency and severity of attacks 1. The goal of treatment is to reduce frequency and severity of attacks while minimizing medication side effects and preventing medication overuse headache, which can occur when acute medications are used more than 10-15 days per month 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. A second dose of sumatriptan tablets or other medication was allowed 4 to 24 hours after the initial treatment for recurrent headache. Acetaminophen was offered to patients in Trials 2 and 3 beginning at 2 hours after initial treatment if the migraine pain had not improved or worsened Additional medications were allowed 4 to 24 hours after the initial treatment for recurrent headache or as rescue in all 3 trials.
The treatment options for migraine therapy include:
- Sumatriptan tablets at doses of 25,50, and 100 mg
- A second dose of sumatriptan tablets for recurrent headache
- Acetaminophen for patients with persistent migraine pain
- Other medications as rescue or for recurrent headache 2
From the Research
Treatment Options for Migraine Therapy
The treatment options for migraine therapy can be categorized into several groups, including:
- Migraine-specific medications, such as triptans 3, 4, 5
- Migraine-nonspecific medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) 3, 4, 5
- Anti-emetics, which can be used to alleviate nausea and vomiting 4, 5
- Ergot alkaloids, which can be used as second- or third-line therapy for select patients or for those with refractory migraine 4, 5
- Combination analgesics, which can be used for mild to moderate migraine attacks 3, 4, 5
First-Line Treatments
First-line treatments for migraine therapy include:
- Acetaminophen, which has been shown to be effective in reducing pain intensity and improving functional disability 6
- NSAIDs, such as ibuprofen, naproxen, and aspirin, which have been shown to be effective in reducing pain intensity and improving functional disability 3, 4, 5
- Triptans, which are effective for moderate to severe migraine attacks and can be used as first-line therapy for these patients 4, 5
Combination Therapy
Combination therapy, such as the combination of a triptan and an NSAID, has been shown to be more effective than monotherapy in some studies 7
- The fixed combination of sumatriptan and naproxen sodium has been shown to offer improved 2-hour and 24-hour benefits over monotherapy 7
Treatment Principles
Several treatment principles can help ensure that migraine treatment is cost-effective, including: