From the Guidelines
Triptans, such as sumatriptan, rizatriptan, and zolmitriptan, are commonly used to treat acute migraine attacks.
First-Line Treatment Options
- Aspirin, ibuprofen, naproxen sodium, and acetaminophen plus aspirin plus caffeine are also effective for the acute treatment of migraine, as shown in studies 1.
- Triptans, including oral naratriptan, rizatriptan, and zolmitriptan, as well as oral and subcutaneous sumatriptan, are effective for acute migraine treatment, with good evidence supporting their use 1.
Administration Route
- A nonoral route of administration may be selected for patients with nausea or vomiting as a significant component of their migraine symptoms, with subcutaneous sumatriptan or DHE nasal spray being options 1.
Additional Treatment Considerations
- Antiemitics, such as metoclopramide, may be used to treat nausea and vomiting associated with migraine attacks, and can be used in conjunction with oral migraine medications in some cases 1.
- Butorphanol nasal spray may be considered for acute migraine treatment when sedation side effects are not a concern and the risk for abuse has been addressed 1.
From the FDA Drug Label
Zolmitriptan tablets are indicated for the acute treatment of migraine with or without aura in adults.
The medication used to treat an acute migraine attack is zolmitriptan (PO) 2.
- Key points:
- Zolmitriptan is indicated for acute treatment of migraine with or without aura in adults.
- It is not indicated for the prevention of migraine attacks.
- Safety and effectiveness have not been established for cluster headache.
From the Research
Medications for Acute Migraine Treatment
The following medications are used to treat acute migraine attacks:
- Aspirin, acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and antiemetic drugs for mild or moderate migraines 3
- Triptans (5-HT1 receptor agonists) for moderate or severe migraine, or when nonspecific medications have been ineffective 3, 4, 5, 6, 7
- Ergotamine and dihydroergotamine for acute migraine treatment, although their use is less common due to the availability of triptans 4, 5, 7
- Combination analgesics containing acetaminophen, aspirin, and caffeine for mild to moderate migraine 5, 7
- Sumatriptan/naproxen for acute migraine treatment 7
Administration and Dosage
The administration and dosage of these medications vary:
- Oral tablets, orally dissolving tablets, subcutaneous injections, nasal sprays, and rectal suppositories are available formulations for triptans 4
- Individualized therapy is necessary for optimal benefit, regarding both the triptan chosen and the formulation 4
- Antiemetics can be used as a supplement to alleviate nausea and vomiting 7
- A combination of a triptan and a NSAID may yield better efficacy compared to either therapy alone 7
Special Considerations
Certain patient populations require special consideration:
- Pregnant women can be treated with acetaminophen or NSAIDs (prior to the third trimester), or opiates in refractory cases 5
- Children and adolescents can be treated with acetaminophen, ibuprofen, intranasal sumatriptan, or intranasal zolmitriptan, although data in these age groups are limited 5
- Patients with vascular disease, uncontrolled hypertension, or hemiplegic migraine should avoid triptans 5