What are the relief packs for migraines?

From the Guidelines

Rel packs for migraines are not the first-line treatment, and NSAIDs such as ibuprofen or naproxen sodium are recommended as the initial treatment for migraines. According to the most recent and highest quality study 1, NSAIDs are the first-line therapy for migraines, and triptans are recommended as second-line therapy. The study suggests that NSAIDs, such as ibuprofen or naproxen sodium, should be used as the initial treatment for migraines, and triptans, such as sumatriptan, should be used if the migraine does not respond to NSAIDs.

Some key points to consider when treating migraines include:

• Using acute medications early in the headache phase of the attack
• Advising patients to try a medication for two to three headache episodes before abandoning that line of therapy
• Considering combining triptans with fast-acting NSAIDs to avert recurrent relapse
• Using prokinetic antiemetics, such as domperidone or metoclopramide, as adjunct oral medications for nausea and/or vomiting
• Avoiding oral ergot alkaloids, opioids, and barbiturates

It's also important to note that the treatment of migraines should be individualized, taking into account the patient's specific needs and medical history. The combination of sumatriptan and naproxen sodium, known as rel packs, may be effective for some patients, but it is not the first-line treatment. The dosage and administration of rel packs should be carefully considered, and patients should be advised to take the medication at the first sign of migraine symptoms with a full glass of water and rest in a quiet, dark room if possible.

In terms of preventive therapies, candesartan, telmisartan, erenumab, fremanezumab, and galcanezumab are recommended for the prevention of episodic migraine 1. These medications have been shown to be effective in reducing the frequency and severity of migraines, and should be considered as part of a comprehensive treatment plan.

Overall, the treatment of migraines requires a comprehensive approach that takes into account the patient's individual needs and medical history. By following the recommended treatment guidelines and considering the patient's specific needs, healthcare providers can help patients manage their migraines effectively.

From the FDA Drug Label

The efficacy of UBRELVY for the acute treatment of migraine was demonstrated in two randomized, double-blind, placebo-controlled trials [Study 1 (NCT02828020) and Study 2 (NCT02867709)]. Study 1 randomized patients to placebo (n=559) or UBRELVY 50 mg (n=556) or 100 mg (n=557) and Study 2 randomized patients to placebo (n=563) or UBRELVY 50 mg (n=562) In all studies, patients were instructed to treat a migraine with moderate to severe headache pain intensity. A second dose of study medication (UBRELVY or placebo), or the patient’s usual acute treatment for migraine, was allowed between 2 to 48 hours after the initial treatment for a non-responding or recurrent migraine headache

Relief Packs for Migraines:

• The studies demonstrate the efficacy of UBRELVY for the acute treatment of migraine.
• UBRELVY is available in 50 mg and 100 mg doses.
• Patients can take a second dose of UBRELVY or their usual acute treatment for migraine between 2 to 48 hours after the initial treatment if the migraine is non-responding or recurrent.
• The primary efficacy analyses were conducted in patients who treated a migraine with moderate to severe pain.
• The efficacy of UBRELVY was established by an effect on pain freedom at 2 hours post-dose and most bothersome symptom (MBS) freedom at 2 hours post-dose, compared to placebo, for Studies 1 and 2 2.

From the Research

Rel Packs for Migraines

• Rel packs, which typically contain a combination of medications, can be effective in treating migraines.
• A study on sumatriptan-naproxen fixed combination tablets found that this combination was effective and well-tolerated for the abortive treatment of migraine 3.
• The combination of sumatriptan and naproxen works by targeting different mechanisms of migraine, with sumatriptan blocking vasoconstriction and transmission of signals to the trigeminal nucleus, and naproxen decreasing neurogenic inflammation in the trigeminal ganglion 3.
• Another study found that sumatriptan plus naproxen was effective in treating acute migraine attacks, with a greater effect when taken early in the attack, when pain was still mild 4.
• The efficacy of sumatriptan has also been compared to other triptans, such as eletriptan, which has been found to be effective in the acute treatment of moderate to severe migraine attacks 5.
• Additionally, a study comparing metoclopramide to sumatriptan in the treatment of migraine in the emergency department found that metoclopramide may be a viable alternative to sumatriptan, with potential benefits including fewer contraindications and side effects 6.

Mechanisms of Action

• Sumatriptan works as a selective serotonin 5-HT1B/1D receptor agonist, blocking vasoconstriction and transmission of signals to the trigeminal nucleus 7.
• Naproxen, a nonsteroidal anti-inflammatory drug (NSAID), decreases neurogenic inflammation in the trigeminal ganglion 3.
• The combination of sumatriptan and naproxen may provide better relief than either medication alone, as they target different mechanisms of migraine 3, 4.

Efficacy and Tolerability

• Sumatriptan-naproxen fixed combination tablets have been found to be effective and well-tolerated for the abortive treatment of migraine 3.
• Sumatriptan plus naproxen has been shown to be effective in treating acute migraine attacks, with a greater effect when taken early in the attack, when pain was still mild 4.
• Eletriptan has been found to be effective in the acute treatment of moderate to severe migraine attacks, with a rapid onset of action and superiority over placebo 5.
• Metoclopramide may be a viable alternative to sumatriptan, with potential benefits including fewer contraindications and side effects 6.