What are the causes and treatments of migraine headaches?

From the Guidelines

For the treatment of acute episodic migraine headache, consider using a triptan and an NSAID or acetaminophen as first-line therapy. This approach is supported by the most recent clinical guideline from the American College of Physicians, published in 2025 1. The guideline recommends starting treatment as soon as possible after the onset of migraine symptoms, using combination therapy to improve efficacy.

Some key points to consider when treating migraine headaches include:

• Using a nonoral triptan and an antiemetic in people having severe nausea or vomiting
• Avoiding the use of opioids or butalbital for the treatment of acute episodic migraine
• Considering the use of the ditan lasmiditan to treat moderate to severe acute episodic migraine headache in nonpregnant outpatient adults who do not tolerate or have inadequate response to all other pharmacologic treatments
• Counseling patients to begin treatment of migraine headache as soon as possible after its onset

In addition to pharmacologic treatments, lifestyle modifications are crucial in managing migraine headaches, including:

• Staying well hydrated
• Maintaining regular meals
• Securing sufficient and consistent sleep
• Engaging in regular physical activity, such as moderate to intense aerobic exercise
• Managing stress with relaxation techniques or mindfulness practices
• Pursuing weight loss for those who are overweight or obese
• Exploring modifiable migraine triggers or contributing factors during a detailed history

It is also important to prescribe less costly recommended medications and to be aware of the potential complication of medication overuse headache, which can occur when acute medication is overused, defined as headache occurring on 15 or more days per month for at least 3 months in people with a preexisting headache disorder 1.

From the FDA Drug Label

Sumatriptan presumably exerts its therapeutic effects in the treatment of migraine headache through agonist effects at the 5-HT1B/1D receptors on intracranial blood vessels and sensory nerves of the trigeminal system, which result in cranial vessel constriction and inhibition of pro-inflammatory neuropeptide release. The estimated probability of achieving an initial headache response within 2 hours following treatment in pooled Studies 1,2,3, and 4 is depicted in Figure 1 The percentage of patients achieving the primary efficacy endpoint of no headache pain at 2 hours after treatment was significantly greater in patients who received rizatriptan benzoate orally disintegrating tablets, compared with those who received placebo (33% vs. 24%) The answer to the question about migraine headaches is that sumatriptan and rizatriptan are two drugs that have been shown to be effective in the treatment of migraine headaches.

• Sumatriptan works by binding to 5-HT1B/1D receptors, which results in cranial vessel constriction and inhibition of pro-inflammatory neuropeptide release 2.
• Rizatriptan has been shown to have a significant effect on headache response, with 33% of patients achieving no headache pain at 2 hours after treatment, compared to 24% with placebo 3. Key points about these drugs include:
• They are both used for the treatment of migraine headaches
• They have different mechanisms of action, but both have been shown to be effective in clinical trials
• The efficacy of these drugs can vary depending on the individual patient and the specific characteristics of their migraine headaches.

From the Research

Migraine Headaches

• Migraine headaches are a common condition that can be managed through lifestyle changes and medication 4
• Lifestyle changes such as maintaining a regular sleep schedule, eating regular meals, exercising regularly, and managing stress can help reduce the frequency and severity of migraine headaches 4
• Medications such as beta-adrenoceptor blockers, flunarizine, topiramate, and valproic acid can be used to prevent migraines, while triptans, ergot derivatives, and nonsteroidal anti-inflammatory drugs can be used to treat acute migraine attacks 4, 5, 6

Treatment Options

• Triptans are a common treatment for acute migraine attacks and have been shown to be effective in reducing pain and improving functional ability 5, 6, 7
• Newer treatments such as lasmiditan, rimegepant, and ubrogepant have been developed and have been shown to be effective in reducing pain and improving functional ability, although they may have a higher risk of adverse events 8
• Combination therapy, such as combining a triptan with a nonsteroidal anti-inflammatory drug, may be more effective than monotherapy in some cases 6
• Acupuncture and botulinum toxin A may also be used as alternative treatments for migraine headaches, although the evidence for their effectiveness is limited 4

Acute Treatment

• The goal of acute treatment is to relieve pain and restore functional ability as quickly as possible 5, 6
• Treatment should be individualized based on the patient's specific needs and medical history 5, 6
• Patients should be advised to treat their migraine attacks early, as delayed treatment can reduce the effectiveness of treatment 5, 6
• Rescue treatment, such as parenteral steroid and fluid supply, may be necessary in some cases, such as status migrainosus 6

Prevention

• Preventive treatment can be used to reduce the frequency and severity of migraine headaches 4
• Medications such as topiramate, valproic acid, and beta-adrenoceptor blockers can be used to prevent migraines 4
• Lifestyle changes, such as maintaining a regular sleep schedule and managing stress, can also help prevent migraines 4