What is the best treatment for migraines?

From the Guidelines

For migraines, the best triptan medication is typically sumatriptan (Imitrex) or ibuprofen, which are considered first-line treatments due to their effectiveness and extensive clinical experience, as recommended by the most recent study 1.

Key Points to Consider

• The standard dosage of sumatriptan is 50-100mg orally at migraine onset, which can be repeated after 2 hours if needed, not exceeding 200mg in 24 hours.
• Sumatriptan is also available as a nasal spray (20mg) or injection (6mg) for faster relief.
• Alternative triptans include rizatriptan (Maxalt, 10mg), which may work faster, or frovatriptan (Frova, 2.5mg), which has a longer duration for extended migraines.
• Ibuprofen is also a recommended treatment option, especially for children and adolescents, as suggested by the study 1.

Important Considerations

• Triptans work by constricting blood vessels and blocking pain pathways in the brain by targeting serotonin receptors.
• They should be taken at the first sign of migraine, not during aura, and are contraindicated in patients with cardiovascular disease, uncontrolled hypertension, or within 24 hours of using other serotonergic medications.
• Side effects may include chest tightness, fatigue, dizziness, and neck pain.
• If one triptan doesn't work well, trying another formulation or a different triptan may provide better relief, as recommended by the study 1.

Additional Recommendations

• Patients should be advised to treat acute migraine early in the attack, and to use a non-oral route of administration if nausea or vomiting is a significant component of the symptom complex, as suggested by the study 1.
• Preventive treatments should be considered in patients with frequent or disabling headaches, or medication overuse, as recommended by the study 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Best Treatment for Migraines

The best treatment for migraines is often debated, but research suggests that sumatriptan is an effective option.

• Sumatriptan is a serotonin1 (5-HT1) receptor agonist that is effective in the acute treatment of migraine headache 2.
• It works by selectively constricting cranial blood vessels and inhibiting neurogenically mediated inflammation in the dura mater 2.
• Studies have shown that sumatriptan reduces migraine headache from 'moderate or severe' to 'mild or none' within 2 hours in 50 to 73% of patients following oral administration of 100 or 200 mg 2.
• Sumatriptan also alleviates accompanying symptoms of nausea, vomiting, and photophobia/phonophobia more effectively than placebo 2.

Efficacy of Sumatriptan

The efficacy of sumatriptan has been studied in several trials, including:

• A study published in the Cochrane database of systematic reviews found that oral sumatriptan was effective in relieving migraine headache and reducing disability 3.
• Another study published in the same journal found that subcutaneous sumatriptan was the most effective route of administration, with pain reduced from moderate or severe to none by two hours in almost 6 in 10 people (59%) taking 6 mg sumatriptan 4.
• A review of Cochrane reviews found that sumatriptan was an effective abortive treatment for acute migraine attacks, but was associated with increased adverse events relative to placebo 4.

Comparison to Other Treatments

Sumatriptan has been compared to other treatments for migraines, including:

• Other triptans, such as naratriptan, rizatriptan, and lysine acetylsalicylate plus metoclopramide 5.
• Ergotamine combinations, which were found to be less effective than sumatriptan 3.
• Non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol (acetaminophen), which were found to be less effective than sumatriptan in some studies 6.

Adverse Events

Sumatriptan is generally well tolerated, but can cause adverse events, including:

• Nausea, vomiting, malaise, and fatigue 2, 5.
• Injection site reactions, which occur in 10 to 40% of patients receiving the drug subcutaneously 5.
• A bitter taste at the back of the mouth, which occurs frequently after intranasal administration 5.
• Serious adverse events, which occur in about 0.14% of patients with migraine treated with sumatriptan 5.