From the Guidelines
Migraine headache management should prioritize a combination of pharmacologic treatments, including a triptan and an NSAID or acetaminophen, as first-line therapy for acute episodic migraine headache in outpatient settings. When managing migraine headaches, several key points should be considered:
- The use of opioids or butalbital for the treatment of acute episodic migraine is not recommended due to potential adverse effects and lack of efficacy 1.
- For patients with severe nausea or vomiting, a nonoral triptan and an antiemetic may be considered to improve treatment outcomes 1.
- In patients of childbearing potential, pregnant, or breastfeeding, it is essential to discuss the potential adverse effects of pharmacologic treatments during pregnancy and lactation 1.
- Counseling patients to begin treatment of migraine headache as soon as possible after its onset, using combination therapy, can improve efficacy 1.
- Lifestyle modifications, including staying well hydrated, maintaining regular meals, securing sufficient and consistent sleep, engaging in regular physical activity, managing stress with relaxation techniques or mindfulness practices, and pursuing weight loss for those who are overweight or obese, are crucial in managing migraine headaches 1.
- Identifying and avoiding personal triggers, keeping a headache diary, and practicing non-pharmacological approaches such as applying cold or warm compresses to the head or neck, resting in a dark, quiet room, and practicing relaxation techniques can provide additional relief.
- The addition of preventive medications may be warranted if the episodic migraine occurs frequently or treatment does not provide an adequate response 1.
- Patients should be aware of medication overuse headache, a potential complication of migraine treatment, and the importance of not overusing acute medications 1.
From the FDA Drug Label
Rizatriptan benzoate is indicated for the acute treatment of migraine attacks with or without aura in adults and in pediatric patients 6 to 17 years old. Eletriptan hydrobromide is indicated for the acute treatment of migraine with or without aura in adults.
Migraine Headache Management:
- Rizatriptan and eletriptan are both used for the acute treatment of migraine attacks.
- They are 5-HT1 agonists, which can cause coronary artery vasospasm, and are contraindicated in patients with ischemic or vasospastic coronary artery disease.
- Before treating headaches, it is essential to exclude other potentially serious neurological conditions.
- Patients with a history of stroke or transient ischemic attack should not receive these medications.
- Medication overuse headache may occur with frequent use of these drugs, and detoxification may be necessary.
- Serotonin syndrome is a potential risk, particularly when co-administered with other serotonergic medications.
- Blood pressure should be monitored, as significant elevation in blood pressure, including hypertensive crisis, has been reported.
- These medications are contraindicated in patients with uncontrolled hypertension or a history of hypersensitivity reaction 2 3.
From the Research
Migraine Headache Management
Migraine headache management involves various approaches, including pharmacological and non-pharmacological methods.
- Pharmacological approaches:
- Triptans, such as rizatriptan, are highly effective in treating migraine attacks, improving headache and nausea, and normalizing functional ability 4, 5, 6, 7.
- Rizatriptan has been shown to be more effective than sumatriptan in some studies, with a faster onset of action and better relief from pain and nausea 4, 6, 7.
- Other triptans, such as almotriptan, eletriptan, frovatriptan, naratriptan, sumatriptan, and zolmitriptan, also have minor differences in efficacy, headache recurrence, and adverse effects 5, 7.
- Non-pharmacological approaches:
- Identifying and avoiding food triggers, such as phenylethylamine, tyramine, aspartame, monosodium glutamate, nitrates, nitrites, alcohol, and caffeine, can help reduce migraine headaches 8.
- Supplements, such as magnesium, Petasites hybridus, feverfew, coenzyme Q10, riboflavin, and alpha lipoic acid, may be effective in preventing migraines 8.
- Lifestyle modifications:
- Making lifestyle modifications, such as maintaining a food diary to identify triggers, can be an inexpensive way to reduce migraine headaches 8.