From the Guidelines
The first line treatment for headaches is typically nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) at 200-400mg every 4-6 hours or naproxen sodium (Aleve) at 220-440mg every 8-12 hours, as recommended by the most recent study 1. When considering treatment options, it's essential to evaluate the patient's specific needs and medical history.
- The most recent study 1 suggests that beta blockers, topiramate, or candesartan can be used as first-line medications for preventive treatment.
- NSAIDs, such as aspirin, ibuprofen, naproxen sodium, tolfenamic acid, and the combination agent acetaminophen plus aspirin plus caffeine, have consistent evidence for first-line therapy 1.
- It's crucial to note that acetaminophen alone is not recommended as a first-line treatment 1.
- For patients whose migraine attack has not responded to NSAIDs, migraine-specific agents like triptans or DHE can be considered 1.
- Preventive therapy should be evaluated for patients who experience frequent or severe headaches, and medications like propranolol, timolol, amitriptyline, divalproex sodium, and sodium valproate can be recommended 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 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, nonsteroidal anti-inflammatory drugs (NSAIDs), and triptans are considered first-line treatments for mild to moderate migraines 3, 4
- Over-the-counter medications such as acetaminophen, ibuprofen, naproxen, and aspirin have shown strong efficacy when used as first-line treatments for mild-to-moderate migraine attacks 3
- Triptans are first-line treatments for moderate to severe migraines 4
Pharmacologic Options
- Acetaminophen, NSAIDs, and triptans have evidence supporting their effectiveness in the treatment of migraine 4, 5
- Calcitonin gene-related peptide receptor antagonists, lasmiditan, dihydroergotamine, and ergotamine plus caffeine are also significantly associated with pain reduction 5
- Antiemetics, butorphanol, and tramadol in combination with acetaminophen may be used, but the evidence is limited 5
Nonpharmacologic Treatments
- Remote electrical neuromodulation, transcranial magnetic stimulation, external trigeminal nerve stimulation, and noninvasive vagus nerve stimulation are significantly associated with improved pain 5
- These nonpharmacologic treatments have varying strength of supporting evidence and may be used in conjunction with pharmacologic treatments 5