From the Guidelines
Medical guidelines for treating migraines prioritize a multi-faceted approach, combining acute treatment for attacks and preventive strategies for frequent sufferers, with the goal of reducing morbidity, mortality, and improving quality of life. For acute migraine attacks, first-line medications include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-600mg) or naproxen (500-550mg), or acetaminophen (1000mg), as recommended by 1. Triptans like sumatriptan (50-100mg orally, 6mg subcutaneously, or 20mg nasally) are effective for moderate to severe migraines and should be taken early in an attack, as advised by 1.
Preventive Treatment
For prevention, beta-blockers such as propranolol (80-240mg daily) or topiramate (25-100mg twice daily) are recommended for patients experiencing four or more migraine days monthly, as suggested by 1. Anti-CGRP monoclonal antibodies like erenumab (70-140mg monthly) or fremanezumab (225mg monthly) represent newer preventive options with fewer side effects, as noted by 1.
Non-Pharmacological Approaches
Non-pharmacological approaches include:
- Identifying and avoiding triggers
- Maintaining regular sleep and meal schedules
- Stress management
- Staying hydrated During an attack, patients should rest in a dark, quiet room and apply cold compresses to the forehead, as these treatments work by reducing inflammation, constricting dilated blood vessels, blocking pain pathways, or preventing the neurological cascade that triggers migraines, as discussed in 1 and 1.
Individualized Treatment
Treatment should be individualized based on migraine frequency, severity, associated symptoms, and patient comorbidities, taking into account the recommendations from 1, 1, 1, and 1. It is essential to consider the patient's specific needs and circumstances when developing a treatment plan, as emphasized by the guidelines and studies referenced.
From the FDA Drug Label
FULL PRESCRIBING INFORMATION 1 INDICATIONS AND USAGE AIMOVIG is indicated for the preventive treatment of migraine in adults. 2 DOSAGE AND ADMINISTRATION 2. 1 Recommended Dosing The recommended dosage of AIMOVIG is 70 mg injected subcutaneously once monthly. Some patients may benefit from a dosage of 140 mg injected subcutaneously once monthly.
The medical guidelines for treating migraines with Erenumab (SQ), as per the drug label, are:
- Indication: Preventive treatment of migraine in adults.
- Dosage:
- Recommended dosage: 70 mg injected subcutaneously once monthly.
- Some patients may benefit from a dosage of 140 mg injected subcutaneously once monthly.
- Administration: Subcutaneous use only, intended for patient self-administration, with proper training on preparation and administration using the single-dose prefilled autoinjector or single-dose prefilled syringe 2.
From the Research
Medical Guidelines for Treating Migraines
The medical guidelines for treating migraines involve a stratified care approach, where the treatment is based on the severity of the migraine attack.
- For mild to moderate migraine attacks, oral nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, diclofenac, ibuprofen, and naproxen are recommended as the first-line medications 3, 4, 5.
- Acetaminophen is also suitable for mild to moderate migraine attacks and is the first choice for children and pregnant women 3, 4, 5.
- For moderate to severe attacks, oral or nasal spray triptans and ergotamine/caffeine compounds are recommended and should be administered in the early stage of migraine attacks 3, 4, 5.
- Antiemetics can be used as a supplement to alleviate nausea and vomiting 3, 4, 5.
- A combination of a triptan and a NSAID has been shown to yield a better efficacy compared with either therapy alone 3.
- Parenteral steroid and fluid supply are the first choice in the treatment of status migrainosus 3.
- Opiates are not recommended for acute migraine treatment due to serious adverse events 3, 4, 5, 6.
Treatment Principles
The treatment principles for migraines include:
- Taking medication early in an attack 5, 6
- Using a stratified treatment approach 3, 4, 5, 6
- Limiting the use of acute treatment to a maximum of ten days a month to prevent medication-overuse headache 3
- Individualizing treatment based on the pattern and severity of attacks, as well as the patient's preferences and medical history 4, 5
Newer Treatment Options
Newer treatment options for migraines include: