Acute Migraine Treatment in Adults

Abstract

There are many options for acute migraine attack treatment, but none is ideal for all patients. This study aims to review current medical office-based acute migraine therapy in adults and provides readers with an organized approach to this important facet of migraine treatment. A general literature review includes a review of several recent published guidelines. Acetaminophen, 4 nonsteroidal anti-inflammatory drugs (NSAIDs) (ibuprofen, acetylsalicylic acid [ASA], naproxen sodium, and diclofenac potassium), and 7 triptans (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan) have good evidence for efficacy and form the core of acute migraine treatment. NSAID-triptan combinations, dihydroergotamine, non-opioid combination analgesics (acetaminophen, ASA, and caffeine), and several anti-emetics (metoclopramide, domperidone, and prochlorperazine) are additional evidence-based options. Opioid containing combination analgesics may be helpful in specific patients, but should not be used routinely. Clinical features to be considered when choosing an acute migraine medication include usual headache intensity, usual rapidity of pain intensity increase, nausea, vomiting, degree of disability, patient response to previously used medications, history of headache recurrence with previous attacks, and the presence of contraindications to specific acute medications. Available acute medications can be organized into 4 treatment strategies, including a strategy for attacks of mild to moderate severity (strategy one: acetaminophen and/or NSAIDs), a triptan strategy for patients with severe attacks and for attacks not responding to strategy one, a refractory attack strategy, and a strategy for patients with contraindications to vasoconstricting drugs. Acute treatment of migraine attacks during pregnancy, lactation, and for patients with chronic migraine is also discussed. In chronic migraine, it is particularly important that medication overuse is eliminated or avoided. Migraine treatment is complex, and treatment must be individualized and tailored to the patient's clinical features. Clinicians should make full use of available medications and formulations in an organized approach.

Acute migraine medication adherence, migraine disability and patient satisfaction: A naturalistic daily diary study

“…These results may not be generalizable to people with migraine where acute medication use requires restraint, such as medication overuse headache, formulary restrictions, or significant medication side effects. In these cases, the use of a more nuanced and stratified acute treatment paradigm according to attack severity would be a key component of a more comprehensive treatment plan (24). Further, participants in this study, on average, had headache for over two decades; these results may not generalize to patients who are newly prescribed acute migraine medications.…”

Efficacy of (S)-lacosamide in preclinical models of cephalic pain

“…Therapies for migraine may be acute or preventative. Currently available acute therapies include non-steroidal anti-inflammatory drugs (NSAIDs), triptans (e.g., serotonin receptor (5-HT1B/1D) agonists), and opioids [4]. These treatments are often inadequate.…”

The Comparıson Of Trıptans, Nsaıd Or Combınatıon On Mıgraıne Attack Treatment

“…Ancak %30-47 oranında rekürrens gözlenmiştir. PAIN A RI [16][17][18][19] Etkin bir tedavi olmasına rağmen rizatriptan iyileşmeyi tam sağlamaması ve tekrarlar nedeniyle yeterli olmayabilmektedir. Bizim çalışmamızda rizatriptan alan grupta birinci saatten sonra ağrı düzeyinin diğer tedavi gruplarına göre daha düşük olduğunu gözlemlendi.…”

“…İki saatte tedaviye yanıt verme oranı rizatriptan grubunda %61.4, diğer oral triptanlar grubunda ortalama %49.4 bulunmuştur. [19,27] Migrenin akut atak tedavisinde NSAİİ ilaçların da etkinliği gösterilmiştir. Migren atak tedavisinde NSAİİ birinci basamak tedaviler arasındadır.…”