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Acute Migraine Treatment in Adults.
Headache. 2015 Jun; 55(6):778-93.H

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.

Authors+Show Affiliations

Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada. The Hotchkiss Brain Institute, Calgary, Alberta, Canada.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

25877672

Citation

Becker, Werner J.. "Acute Migraine Treatment in Adults." Headache, vol. 55, no. 6, 2015, pp. 778-93.
Becker WJ. Acute Migraine Treatment in Adults. Headache. 2015;55(6):778-93.
Becker, W. J. (2015). Acute Migraine Treatment in Adults. Headache, 55(6), 778-93. https://doi.org/10.1111/head.12550
Becker WJ. Acute Migraine Treatment in Adults. Headache. 2015;55(6):778-93. PubMed PMID: 25877672.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute Migraine Treatment in Adults. A1 - Becker,Werner J, Y1 - 2015/04/15/ PY - 2015/02/20/accepted PY - 2015/4/17/entrez PY - 2015/4/17/pubmed PY - 2016/3/15/medline KW - acute KW - adult KW - migraine KW - nonsteroidal anti-inflammatory drug KW - treatment KW - triptan SP - 778 EP - 93 JF - Headache JO - Headache VL - 55 IS - 6 N2 - 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. SN - 1526-4610 UR - https://www.unboundmedicine.com/medline/citation/25877672/Acute_Migraine_Treatment_in_Adults_ DB - PRIME DP - Unbound Medicine ER -