What are the treatment options for migraine headaches?

From the Guidelines

Migraines can be effectively treated with both acute and preventive approaches, with the most recent and highest quality study recommending a stepped care approach for individualized therapy 1. For acute treatment, over-the-counter medications like ibuprofen (400-600mg) are recommended for children and adolescents, while sumatriptan/naproxen oral, zolmitriptan nasal, sumatriptan nasal, rizatriptan ODT, or almotriptan oral can be considered for adolescents 1.

Acute Treatment Options

• Ibuprofen (400-600mg) for mild migraines
• Sumatriptan (50-100mg orally, 6mg subcutaneously, or 20mg nasal spray) for moderate to severe migraines
• Anti-nausea medications like metoclopramide (10mg) or ondansetron (4-8mg) to address associated symptoms

Preventive Treatment Options

• Beta-blockers like propranolol (80-240mg daily) for chronic sufferers (4+ migraines monthly)
• Anticonvulsants such as topiramate (50-200mg daily)
• Certain antidepressants
• CGRP antagonists like erenumab (70-140mg monthly injection)

Non-Medication Approaches

• Identifying and avoiding triggers (certain foods, stress, irregular sleep)
• Maintaining regular sleep patterns
• Staying hydrated
• Practicing stress management techniques like meditation
• Resting in a dark, quiet room during an attack to reduce sensory stimulation that worsens symptoms.

It is essential to consider the individual patient's needs and preferences when selecting a treatment approach, and to monitor and adjust the treatment plan as needed to achieve the best possible outcome, as recommended by the most recent study 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. In all 3 trials, the percentage of patients achieving headache response 2 and 4 hours after treatment was significantly greater among patients receiving sumatriptan tablets at all doses compared with those who received placebo The results from the 3 controlled clinical trials are summarized in Table 2. For patients with migraine-associated nausea, photophobia, and/or phonophobia at baseline, there was a lower incidence of these symptoms at 2 hours (Trial 1) and at 4 hours (Trials 1,2, and 3) following administration of sumatriptan tablets compared with placebo

Treatment for Migraine: Sumatriptan tablets are effective in the acute treatment of migraine headaches.

• The medication has been shown to be effective at doses of 25,50, and 100 mg, with a significant percentage of patients achieving headache response 2 and 4 hours after treatment.
• Sumatriptan tablets have also been shown to reduce the incidence of migraine-associated symptoms such as nausea, photophobia, and phonophobia. 2

From the Research

Treatment Options for Migraine

• Acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), triptans, antiemetics, ergot alkaloids, and combination analgesics have evidence supporting their effectiveness in the treatment of migraine 3
• NSAIDs and triptans are the mainstays of acute migraine therapy, and antiemetic drugs can be added as necessary 4
• Dihydroergotamine (DHE) is also suitable for selected patients 4

First-Line Treatments

• Acetaminophen and NSAIDs are first-line treatments for mild to moderate migraines 3
• Triptans are first-line treatments for moderate to severe migraines 3

Treatment Strategies

• The acetaminophen-NSAID strategy is suitable for patients with attacks of mild to moderate severity 4
• The triptan strategy is suitable for patients with severe attacks and for those with attacks of moderate severity who do not respond well to NSAIDs 4
• The refractory migraine strategies may be useful for patients who do not respond well to the NSAIDs or triptans alone and include using triptans and NSAIDs simultaneously in combination, DHE, and rescue medications (eg, dopamine antagonists, combination analgesics, and corticosteroids) when the patient's usual medications fail 4

Combination Therapy

• Sumatriptan plus naproxen is effective in the acute treatment of migraine headaches, with a greater effect than for the same dose of either sumatriptan or naproxen alone 5
• Treating early, when pain was still mild, was significantly better than treating once pain was moderate or severe for pain-free responses at two hours and during the 24 hours post dose 5

Special Considerations

• Acetaminophen is the safest acute migraine drug during pregnancy, and acetaminophen with codeine is also an option 4
• Sumatriptan may be an option during pregnancy for selected patients and is compatible with breast-feeding 4
• Opioids and combination analgesics containing opioids should not be used routinely 4