From the Guidelines
Management of a new diagnosis of migraine with aura should prioritize preventive strategies, including pharmacologic treatments and lifestyle modifications, to reduce the frequency and severity of migraine headache and improve quality of life. According to the American College of Physicians' clinical guideline on the prevention of episodic migraine headache, published in 2025 1, the main goal of prevention is to reduce the frequency and severity of migraine headache. Considerations for preventive pharmacologic treatments for episodic migraine include frequency, severity, duration, and functional disability.
Pharmacologic Treatments
For preventive pharmacologic treatments, first-line options include propranolol, topiramate, and valproate, which have been granted U.S. Food and Drug Administration (FDA) approval for migraine prevention 1. Additionally, newer options such as calcitonin gene-related peptide antagonists (CGRP antagonists-gepants) and monoclonal antibodies (CGRP-mAbs) are available. The choice of pharmacologic treatment should be based on the patient's values and preferences, as well as consideration of the comparative benefits and harms of these treatments.
Lifestyle Modifications
Lifestyle modifications are also crucial in the management of migraine with aura. These include:
- Maintaining regular sleep patterns
- Eating regular meals
- Staying hydrated
- Managing stress through relaxation techniques
- Identifying and avoiding personal triggers
- Keeping a headache diary to track frequency, severity, triggers, and medication effectiveness
Special Considerations
Patients with migraine with aura should avoid combined hormonal contraceptives due to increased stroke risk, especially if they smoke or have other cardiovascular risk factors. Regular follow-up is important to assess treatment effectiveness and adjust as needed. By prioritizing preventive strategies and lifestyle modifications, patients with migraine with aura can reduce the frequency and severity of migraine headache and improve their quality of life.
From the FDA Drug Label
Sumatriptan tablets, USP are a serotonin (5-HT1B/1D) receptor agonist (triptan) indicated for acute treatment of migraine with or without aura in adults. Use only if a clear diagnosis of migraine headache has been established. The efficacy of sumatriptan tablets was unaffected by presence of aura; Sumatriptan tablets, USP are indicated for the acute treatment of migraine with or without aura in adults.
The management of a new diagnosis of migraine with aura involves the use of sumatriptan tablets for acute treatment.
- The dosage is a single dose of 25 mg, 50 mg, or 100 mg tablet.
- A second dose should only be considered if some response to the first dose was observed, with at least 2 hours between doses.
- The maximum dose in a 24-hour period is 200 mg.
- It is essential to establish a clear diagnosis of migraine headache before using sumatriptan tablets.
- The presence of aura does not affect the efficacy of sumatriptan tablets 2, 2, 2.
From the Research
Management of New Diagnosis of Migraine with Aura
The management of migraine with aura involves both acute and preventive treatment strategies.
- Acute treatment options include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen sodium, diclofenac potassium, and acetylsalicylic acid 3
- Triptans such as sumatriptan, rizatriptan, eletriptan, zolmitriptan, almotriptan, frovatriptan, and naratriptan 3, 4
- Antiemetic drugs and ergot alkaloids for select patients or refractory migraine 3, 4
- Preventive treatment options include:
- Oral treatments such as topiramate and valproate, which are effective for migraine prophylaxis 5
- Monoclonal antibodies targeting calcitonin gene-related peptide (CGRP) or its receptor, which have high efficacy and are well tolerated 6
- Neuromodulation devices, including external trigeminal nerve stimulation and single-pulse transcranial magnetic stimulation devices, which have modest evidence to support preventive use 6
Treatment Principles
- Treatment should be individualized based on the pattern and severity of attacks 4
- Acute medications should be taken early in an attack, and a stratified treatment approach can help ensure cost-effective treatment 4
- Preventive treatment should be started with a low dose and titrated slowly, with an adequate treatment trial duration and established expectations of therapeutic response and adverse events 7