From the Guidelines
Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line therapy for headaches, specifically aspirin, ibuprofen, naproxen sodium, and the combination agent acetaminophen plus aspirin plus caffeine.
Medication Options
- Aspirin: effective for acute treatment of migraine 1
- Ibuprofen: effective for acute treatment of migraine 1
- Naproxen sodium: effective for acute treatment of migraine 1
- Acetaminophen plus aspirin plus caffeine: effective for acute treatment of migraine 1
- Triptans (e.g. naratriptan, rizatriptan, sumatriptan, zolmitriptan): effective for acute treatment of migraine, especially in patients who do not respond to NSAIDs [(1, 2)]
- Dihydroergotamine (DHE) nasal spray: effective for acute treatment of migraine 2 ### Important Considerations
- Acetaminophen alone is not effective for acute treatment of migraine [(1, 2)]
- Antiemitics should be used to treat nausea and vomiting, which are common symptoms of migraine [(1, 3)]
- Nonoral routes of administration should be considered for patients with nausea or vomiting [(1, 3)]
From the Research
Medications for Headaches
- Acetaminophen is used to treat mild or moderate migraines 4, 5, 6
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen are used to treat mild or moderate migraines 4, 5, 6
- Triptans (5-HT1 receptor agonists) are used to treat moderate or severe migraine 4, 5, 6
- Antiemetic drugs are used to treat nausea and vomiting associated with migraines 4
- Isometheptene is used to treat mild or moderate migraines 4
- Gepants, such as rimegepant or ubrogepant, are used to treat acute migraine 6
- Lasmiditan, a 5-HT1F agonist, is used to treat acute migraine 6
- Opioids, such as short-acting opioids, may be considered for severe migraine attacks when other treatments are contraindicated or ineffective 7
Specific Medications for Migraines
- Sumatriptan, the first triptan used, is effective but can induce adverse events 4
- Second-generation triptans (zolmitriptan, naratriptan, rizatriptan, and almotriptan) were developed to increase the benefit-to-risk ratio in migraine management 4
- OnabotulinumtoxinA is used as a preventive treatment for migraines 8, 6
- Calcitonin gene-related peptide monoclonal antibodies are used as preventive treatments for migraines 6
Considerations for Medication Use
- Medication-overuse headache (MOH) is a chronic daily headache caused by frequent use of acute medications 8
- The risk of MOH is increased with frequent use of butalbital, opioids, triptans, and combination analgesics 8
- Acute migraine treatment should be limited to 2 or fewer days per week to avoid MOH 8
- Patients with cardiovascular disease should avoid triptans due to vasoconstrictive properties 6