From the Guidelines
The first line treatment for headaches is typically nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen sodium, or aspirin, as they have the most consistent evidence for effectiveness in managing acute migraine attacks 1.
Key Considerations
- The most recent and highest quality study recommends considering preventive treatment in patients who are adversely affected by migraine on ≥2 days per month despite optimized acute treatment 1.
- NSAIDs such as ibuprofen (400-600mg every 6-8 hours) or naproxen sodium (220-440mg every 8-12 hours) are recommended as first-line therapy for acute migraine attacks 1.
- Aspirin, tolfenamic acid, and the combination agent acetaminophen plus aspirin plus caffeine also have consistent evidence for effectiveness in managing acute migraine attacks 1.
- For patients whose migraines present early with nausea or vomiting, a nonoral route of administration and antiemetic treatment should be considered 1.
Additional Recommendations
- Staying hydrated by drinking 8-10 glasses of water daily, applying a cold or warm compress to the forehead or neck for 15 minutes, and resting in a quiet, dark room can provide additional relief.
- If headaches are frequent or severe, keeping a headache diary to identify triggers like certain foods, stress, or sleep patterns can help prevent future episodes.
- If over-the-counter medications don't provide relief, or if headaches are severe, persistent, or accompanied by other symptoms like fever or stiff neck, medical attention should be sought as prescription medications or further evaluation may be needed.
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 trials, doses of 25,50, and 100 mg were compared with placebo in the treatment of migraine attacks. 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
First line for headaches: Sumatriptan tablets are a viable option for the acute treatment of migraine headaches.
- The recommended doses are 25,50, and 100 mg, with all doses showing significant efficacy compared to placebo.
- 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 2
From the Research
First-Line Treatments for Headaches
- Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are considered first-line treatments for mild to moderate migraines 3, 4
- Triptans are first-line treatments for moderate to severe migraines 4, 5
- Over-the-counter medications, such as acetaminophen, ibuprofen, naproxen, and aspirin, are effective and preferred for their lower cost and fewer adverse effects 3
Treatment Principles
- Taking medication early in an attack and using a stratified treatment approach can help ensure that migraine treatment is cost-effective 4
- Identifying and managing environmental, dietary, and behavioral triggers are useful strategies for preventing migraines 6
Non-Pharmacologic Treatments
- Nonpharmacologic treatments, such as relaxation training, thermal biofeedback combined with relaxation training, electromyographic feedback, and cognitive behavior therapy, have good evidence to support their use in migraine prevention 6
- Remote electrical neuromodulation, transcranial magnetic stimulation, external trigeminal nerve stimulation, and noninvasive vagus nerve stimulation are significantly associated with improved pain 5