What treatment options are available for recurring migraines that are not responding to ibuprofen (Ibuprofen) and aspirin (Acetylsalicylic acid)?

Treatment for Recurring Migraines Not Responding to Ibuprofen and Aspirin

For recurring migraines not responding to ibuprofen and aspirin, Excedrin (acetaminophen-aspirin-caffeine combination) is an effective first-line treatment option that should be tried before moving to prescription medications. 1

First-Line Treatment Options

Over-the-Counter Options

• Excedrin Migraine (acetaminophen-aspirin-caffeine combination):

  • Highly effective for migraine pain relief 2
  • Demonstrated significant pain reduction compared to placebo in multiple studies
  • Can reduce pain to mild or none in 59.3% of patients within 2 hours 2
  • Also helps alleviate associated symptoms like nausea, photophobia, and phonophobia 2
  • Take at onset of migraine symptoms for maximum effectiveness 1

• Other NSAID options if you haven't tried them:

  • Naproxen sodium (500-550mg) 1

Important Usage Guidelines

• Take medication early in the headache phase for maximum effectiveness 1
• Limit use to no more than twice weekly to prevent medication overuse headache 1
• Do not exceed 14 days per month of Excedrin Migraine to avoid medication overuse headache 1

When First-Line Treatments Fail

If Excedrin and other NSAIDs don't provide relief:

Second-Line Options (Require Prescription)

1. Triptans (serotonin 5-HT1B/D agonists):

   • Recommended for moderate to severe migraines or when NSAIDs fail 3, 1
   • Options include sumatriptan, rizatriptan, naratriptan, and zolmitriptan
   • Contraindicated in patients with uncontrolled hypertension, basilar or hemiplegic migraine, and cardiovascular disease 1

2. Newer Options when triptans fail or are contraindicated:

   • Gepants (CGRP antagonists) like ubrogepant or rimegepant
   • Ditans (5-HT1F agonists) like lasmiditan 1

When to Consider Preventive Treatment

Consider preventive therapy if you experience:

• Two or more migraine attacks per month with disability lasting 3+ days per month
• Use of acute medications more than twice per week
• Failure of acute treatments 3, 1

Effective Preventive Options

• Beta blockers (propranolol 80-240 mg/day)
• Tricyclic antidepressants (amitriptyline 30-150 mg/day)
• Anticonvulsants (divalproex sodium 500-1500 mg/day) 3, 1

Special Considerations

For Migraines with Significant Nausea/Vomiting

• Consider non-oral routes of administration
• Add an antiemetic medication to treat nausea 3, 1

Avoid These Medications

• Limit use of medications containing opiates or barbiturates for acute migraine 4
• These should only be considered when other options have failed 1

Warning Signs to Seek Immediate Medical Attention

• Sudden onset of the "worst headache of your life"
• New headache after age 50
• Headache with fever, neck stiffness, confusion, seizures, or neurological deficits
• Headache following head trauma

Remember that early treatment is key to effective migraine management, and consistent overuse of any acute medication can lead to medication overuse headache, making your migraines more frequent and difficult to treat.