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Acute Migraine Treatment.
Continuum (Minneap Minn). 2015 Aug; 21(4 Headache):953-72.C

Abstract

PURPOSE OF REVIEW

This article provides a systematic, evidence-based approach to acute medication choices for the patient with migraine.

RECENT FINDINGS

Recent clinical trials, meta-analyses, and practice guidelines have confirmed that four nonsteroidal anti-inflammatory drugs (NSAIDs) with randomized controlled trial evidence for efficacy in migraine (ibuprofen, naproxen sodium, diclofenac potassium, and acetylsalicylic acid) and seven triptans (sumatriptan, rizatriptan, eletriptan, zolmitriptan, almotriptan, frovatriptan, and naratriptan) are appropriate medications for acute migraine treatment. Dihydroergotamine (DHE) is also suitable for selected patients.

SUMMARY

NSAIDs and triptans are the mainstays of acute migraine therapy, and antiemetic drugs can be added as necessary. Opioids and combination analgesics containing opioids should not be used routinely. Patient-specific clinical features should help guide the selection of an acute medication for an individual patient. Acute medications can be organized into four treatment strategies for use in various clinical settings. The acetaminophen-NSAID strategy is suitable for patients with attacks of mild to moderate severity. The triptan strategy is suitable for patients with severe attacks and for those with attacks of moderate severity who do not respond well to NSAIDs. The refractory migraine strategies may be useful for patients who do not respond well to the NSAIDs or triptans alone and include using triptans and NSAIDs simultaneously in combination, DHE, and rescue medications (eg, dopamine antagonists, combination analgesics, and corticosteroids) when the patient's usual medications fail. Strategies for patients with contraindications to vasoconstricting drugs include use of NSAIDs, combination analgesics, and dopamine antagonists.Acetaminophen is the safest acute migraine drug during pregnancy, and acetaminophen with codeine is also an option. Sumatriptan may be an option during pregnancy for selected patients and is compatible with breast-feeding.

Authors

No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

26252584

Citation

Becker, Werner J.. "Acute Migraine Treatment." Continuum (Minneapolis, Minn.), vol. 21, no. 4 Headache, 2015, pp. 953-72.
Becker WJ. Acute Migraine Treatment. Continuum (Minneap Minn). 2015;21(4 Headache):953-72.
Becker, W. J. (2015). Acute Migraine Treatment. Continuum (Minneapolis, Minn.), 21(4 Headache), 953-72. https://doi.org/10.1212/CON.0000000000000192
Becker WJ. Acute Migraine Treatment. Continuum (Minneap Minn). 2015;21(4 Headache):953-72. PubMed PMID: 26252584.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute Migraine Treatment. A1 - Becker,Werner J, PY - 2015/8/8/entrez PY - 2015/8/8/pubmed PY - 2016/11/1/medline SP - 953 EP - 72 JF - Continuum (Minneapolis, Minn.) JO - Continuum (Minneap Minn) VL - 21 IS - 4 Headache N2 - PURPOSE OF REVIEW: This article provides a systematic, evidence-based approach to acute medication choices for the patient with migraine. RECENT FINDINGS: Recent clinical trials, meta-analyses, and practice guidelines have confirmed that four nonsteroidal anti-inflammatory drugs (NSAIDs) with randomized controlled trial evidence for efficacy in migraine (ibuprofen, naproxen sodium, diclofenac potassium, and acetylsalicylic acid) and seven triptans (sumatriptan, rizatriptan, eletriptan, zolmitriptan, almotriptan, frovatriptan, and naratriptan) are appropriate medications for acute migraine treatment. Dihydroergotamine (DHE) is also suitable for selected patients. SUMMARY: NSAIDs and triptans are the mainstays of acute migraine therapy, and antiemetic drugs can be added as necessary. Opioids and combination analgesics containing opioids should not be used routinely. Patient-specific clinical features should help guide the selection of an acute medication for an individual patient. Acute medications can be organized into four treatment strategies for use in various clinical settings. The acetaminophen-NSAID strategy is suitable for patients with attacks of mild to moderate severity. The triptan strategy is suitable for patients with severe attacks and for those with attacks of moderate severity who do not respond well to NSAIDs. The refractory migraine strategies may be useful for patients who do not respond well to the NSAIDs or triptans alone and include using triptans and NSAIDs simultaneously in combination, DHE, and rescue medications (eg, dopamine antagonists, combination analgesics, and corticosteroids) when the patient's usual medications fail. Strategies for patients with contraindications to vasoconstricting drugs include use of NSAIDs, combination analgesics, and dopamine antagonists.Acetaminophen is the safest acute migraine drug during pregnancy, and acetaminophen with codeine is also an option. Sumatriptan may be an option during pregnancy for selected patients and is compatible with breast-feeding. SN - 1538-6899 UR - https://www.unboundmedicine.com/medline/citation/26252584/Acute_Migraine_Treatment_ L2 - https://doi.org/10.1212/CON.0000000000000192 DB - PRIME DP - Unbound Medicine ER -