What can be given to someone with migraines to minimize side effects?

Treatment Options for Migraines with Minimal Side Effects

For most migraine sufferers, nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment option with the most favorable side effect profile. 1

First-Line Treatments

NSAIDs for Mild to Moderate Migraines

• Aspirin, ibuprofen, and naproxen sodium have the most consistent evidence supporting their efficacy for mild to moderate migraines 1, 2
• These medications work by inhibiting cyclooxygenase enzymes, reducing prostaglandin synthesis and inflammation 2
• Typical dosing:
  • Ibuprofen: 400-800mg every 6-8 hours as needed 2
  • Aspirin: 900-1000mg as needed 2
  • Naproxen sodium: dosing varies by formulation 1
• The combination of acetaminophen, aspirin, and caffeine is also effective 1
• Note: Acetaminophen alone is not recommended for migraine treatment 1, 3

Triptans for Moderate to Severe Migraines

• For moderate to severe migraines or when NSAIDs are ineffective, triptans are recommended 1, 2
• Triptans activate serotonin receptors, causing cranial vessel constriction and inhibiting vasoactive neuropeptide release 2
• Options with good evidence include:
  • Oral sumatriptan (25-100mg), rizatriptan, and zolmitriptan 1, 4
  • Subcutaneous sumatriptan (6mg) 1, 2
• Take triptans early in an attack for optimal effectiveness, but not during the aura phase 2, 5

Special Considerations

For Migraines with Nausea/Vomiting

• Select a non-oral route of administration when nausea or vomiting are significant components 1, 2
• Add an antiemetic medication to treat nausea 1, 2
• Options include:
  • Metoclopramide: treats nausea and improves gastric motility 1, 2
  • Prochlorperazine: can effectively relieve both headache pain and nausea 1, 2

Contraindications and Precautions

• Triptans should not be used in patients with:
  • Uncontrolled hypertension 1, 2
  • Basilar or hemiplegic migraine 1, 2
  • Significant cardiovascular disease 2, 5
• NSAIDs should be closely monitored as overuse may lead to rebound headaches 1
• Limit acute treatments to no more than twice weekly to prevent medication overuse headache 1, 2

Algorithm for Treatment Selection

1. For mild to moderate migraines without significant nausea:

   • Start with NSAIDs (ibuprofen, aspirin, or naproxen) 1
   • If ineffective, try combination of acetaminophen, aspirin, and caffeine 1

2. For moderate to severe migraines without significant nausea:

   • Start with a triptan (sumatriptan, rizatriptan, or zolmitriptan) 1, 2
   • Sumatriptan dosing: 25-100mg orally (50mg may be as effective as 100mg with fewer side effects) 4

3. For migraines with significant nausea or vomiting:

   • Use non-oral route of administration (subcutaneous sumatriptan or nasal spray) 1, 2
   • Add an antiemetic (metoclopramide or prochlorperazine) 1, 2

Preventive Treatment

Consider preventive therapy if:

• Two or more migraine attacks per month that produce disability lasting 3 or more days 1
• Use of acute medications more than twice per week 1, 2
• Failure of or contraindications to acute treatments 1, 6

First-line preventive options include:

• Beta-blockers: propranolol (80-240mg/day) or timolol (20-30mg/day) 1, 2
• Antidepressants: amitriptyline (30-150mg/day) 1, 2
• Anticonvulsants: divalproex sodium (500-1500mg/day) or sodium valproate (800-1500mg/day) 1, 2