From the Guidelines
Migraine treatment should prioritize a combination of medication and lifestyle modifications, with a focus on early intervention and prevention. For acute migraine attacks, the most recent and highest quality study 1 recommends using ibuprofen to treat pain in children and adolescents, while in adolescents, sumatriptan/naproxen oral, zolmitriptan nasal, sumatriptan nasal, rizatriptan ODT, or almotriptan oral may also be considered.
Key Recommendations
- Take a detailed history and make a specific headache diagnosis to guide treatment decisions 1
- Advise patients and families on lifestyle factors, migraine triggers, and avoidance of acute medication overuse to prevent frequent or disabling headaches 1
- Counsel patients to treat acute migraine early in the attack to improve treatment outcomes 1
- Consider preventive treatments in children/adolescents with frequent or disabling headaches or medication overuse to reduce migraine frequency and severity 1
Medication Options
- Over-the-counter pain relievers like ibuprofen (400-600mg) or acetaminophen (1000mg) may help if taken early
- Prescription triptans such as sumatriptan (50-100mg orally) are more effective for moderate to severe migraines and should be taken at the first sign of headache
- For prevention, medications like propranolol (80-160mg daily), topiramate (50-100mg daily), or amitriptyline (10-50mg at bedtime) may be prescribed for daily use
Lifestyle Modifications
- Maintain regular sleep patterns
- Stay hydrated
- Avoid known triggers (certain foods, alcohol, stress)
- Practice stress management techniques like meditation
- During an attack, resting in a dark, quiet room can help reduce symptoms These treatments work by addressing the neurological and vascular changes that occur during migraines, including inflammation, vasodilation, and abnormal brain activity. A combination approach typically yields the best results for managing this complex neurological condition.
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 estimated probability of achieving an initial headache response over the 4 hours following treatment in pooled Trials 1,2, and 3 is depicted in Figure 1.
Migraine Treatment with Sumatriptan:
- Sumatriptan is effective in the acute treatment of migraine headaches.
- The percentage of patients achieving headache response 2 and 4 hours after treatment is significantly greater with sumatriptan compared to placebo.
- Key doses of sumatriptan used in the trials were 25,50, and 100 mg.
- Headache response was defined as a reduction in headache severity from moderate or severe pain to mild or no pain.
- Sumatriptan also reduced the incidence of migraine-associated symptoms such as nausea, photophobia, and phonophobia 2.
From the Research
Migraine Treatment Options
- Acute treatment for migraine is available in various forms, including triptans, ergot derivatives, and nonsteroidal anti-inflammatory drugs (NSAIDs) 3, 4.
- The American Headache Society recommends the use of triptans, acetaminophen, and NSAIDs as first-line treatments for acute migraine attacks 3.
- New classes of acute treatment, such as small-molecule calcitonin gene-related peptide receptor antagonists (gepants) and a 5-HT1F receptor agonist (lasmiditan), have been developed and offer alternative options for patients 4.
- Noninvasive neuromodulation is also a viable option for acute migraine therapy, with remote electrical neuromodulation showing the strongest evidence 4, 5.
Treatment Strategies
- The concept of "stratified care" is recommended, where treatment is tailored to the severity of the migraine attack 3.
- For mild to moderate migraine attacks, oral NSAIDs are the first choice, while for moderate to severe attacks, oral or nasal spray triptans and ergotamine/caffeine compounds are recommended 3.
- Combination therapy, such as a triptan and a NSAID, may yield better efficacy than either therapy alone 3.
- Antiemetics can be used as a supplement to alleviate nausea and vomiting 3.
Special Considerations
- Acetaminophen is suitable for mild to moderate migraine attacks and remains the first choice for children and pregnant women 3.
- Opiates are not recommended for acute migraine treatment due to serious adverse events 3.
- Medication-overuse headache can be prevented by limiting the use of acute treatment to a maximum of ten days a month 3.
- Prophylactic treatment, including avoidance of trigger factors and lifestyle advice, as well as medications such as beta-blockers and topiramate, can also be effective in managing migraine 6, 7.