What is the abortive therapy for migraine (acute treatment for migraine headache)?

From the Guidelines

Abortive therapy for migraine should start with NSAIDs such as ibuprofen (400-600mg) or naproxen (500-550mg) for mild to moderate migraines, and triptans like sumatriptan (50-100mg orally, 6mg subcutaneously, or 20mg intranasally) for moderate to severe migraines, as these have been shown to be effective in reducing inflammation and pain 1.

Key Considerations

• For patients with nausea or vomiting, a non-oral route of administration should be selected, and antiemetics like metoclopramide (10mg) or prochlorperazine (10mg) can be added to treat nausea and vomiting 1.
• Combination medications such as acetaminophen/aspirin/caffeine (Excedrin Migraine) may also be effective for some patients 1.
• Patients should limit use of abortive medications to 2-3 days per week to avoid medication overuse headaches, and those with cardiovascular disease should avoid triptans due to their vasoconstrictive properties 1.

Treatment Options

• NSAIDs: ibuprofen (400-600mg), naproxen (500-550mg) 1
• Triptans: sumatriptan (50-100mg orally, 6mg subcutaneously, or 20mg intranasally), naratriptan, rizatriptan, zolmitriptan 1
• Antiemetics: metoclopramide (10mg), prochlorperazine (10mg) 1
• Combination medications: acetaminophen/aspirin/caffeine (Excedrin Migraine) 1

Special Considerations

• Patients with cardiovascular disease should avoid triptans due to their vasoconstrictive properties 1.
• If first-line treatments fail, newer options like gepants (rimegepant 75mg, ubrogepant 50-100mg) or ditans (lasmiditan 50-200mg) may be considered as they work through different mechanisms and have fewer cardiovascular contraindications.

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. Dihydroergotamine Mesylate Injection is indicated for the acute treatment of migraine headaches with or without aura and the acute treatment of cluster headache episodes.

The abortive therapy for migraine (acute treatment for migraine headache) includes:

• Sumatriptan (PO): available in doses of 25,50, and 100 mg, which have been shown to be effective in the treatment of migraine attacks 2
• Dihydroergotamine (PO): indicated for the acute treatment of migraine headaches with or without aura 3

From the Research

Abortive Therapy for Migraine

The abortive therapy for migraine, also known as acute treatment, aims to relieve the symptoms of a migraine headache. Several options are available, including:

• Triptans: a class of drugs that include sumatriptan, almotriptan, eletriptan, rizatriptan, zolmitriptan, naratriptan, and frovatriptan 4, 5, 6, 7
• Non-steroidal anti-inflammatory drugs (NSAIDs): such as naproxen, which can be used alone or in combination with triptans 4
• Sumatriptan plus naproxen: a combination of a triptan and an NSAID, which has been shown to be effective in treating migraine headaches 4

Efficacy of Abortive Therapies

Studies have compared the efficacy of different abortive therapies for migraine, including:

• Sumatriptan: has been shown to be effective in relieving migraine symptoms, with a number needed to treat (NNT) of 6.1 for pain-free response at two hours 5
• Almotriptan: has been shown to be similar in efficacy to sumatriptan, with a headache relief rate of 58.0% at two hours 6
• Eletriptan: has been shown to be one of the most effective triptans, with a high treatment effect estimate for pain-free response at two hours 7
• Sumatriptan plus naproxen: has been shown to be more effective than sumatriptan alone, with a NNT of 3.1 for pain-free response at two hours 4

Route of Administration

The route of administration can also affect the efficacy of abortive therapies, with:

• Subcutaneous administration: being the most effective, with a NNT of 2.3 for pain-free response at two hours 8
• Oral administration: being less effective, but still providing clinically useful pain relief, with a NNT of 6.1 for pain-free response at two hours 8
• Intranasal administration: being effective, with a NNT of 3.5 for headache relief at two hours 8
• Rectal administration: being less effective, but still providing some pain relief, with a NNT of 2.4 for headache relief at two hours 8

Adverse Events

Abortive therapies can also cause adverse events, including:

• Mild or moderate severity: adverse events, such as nausea, dizziness, and somnolence, which are common with triptans and NSAIDs 4, 5, 6, 7, 8
• Serious adverse events: such as chest pain, which are rare but can occur with triptans 6