Key Concepts for acute treatment: 

  • The goal is to return to function or at least a decrease symptoms
  • Try different options with your care provider 
  • Record results in your diary
  • Treat early, it will increase your success rate 
  • For severe attacks, discuss combinations with your care provider 
  • If you have nausea, use specific medications for it 
  • Use other options than pills for severe attacks (nasal sprays, injections, etc.)
  • Natural techniques (hot, cold, mint rollers, acupressure, breathing exercises) can help 
  • May use different options for attacks of different severity
  • Avoid overuse, if you are at risk consider prevention 
  • Gepants do not lead to medication overuse headache 
  • Cannabis is better avoided for migraine treatment until more research is available 
  • Avoid opioids, they should be only a last resort
Medication Brand names How they work Side effects
Analgesics Acetaminophen
Paracetamol		 Tylenol Probably block inflammation Usually well-tolerated. Overdose may lead to death. Overuse may lead to more headaches.
Anti-inflammatories NSAIDs Ibuprofen
Diclofenac
Ketorolac
Naproxen
ASA		 Advil,
Motrin
Cambia,
Voltaren
Toradol
Aleve
Aspirin		 Block COX enzyme, decrease prostaglandins = less inflammation Stomach irritation, ulcers. High blood pressure. Small risk of heart disease.
Triptans Almotriptan
Eletriptan
Frovatriptan
Naratriptan
Rizatriptan
Sumatriptan
Zolmitriptan		 Axert
Relpax
Frova
Amerge
Maxalt
Imitrex
Zomig		 Act on the serotonin system (stimulates 5HT 1b-d receptors) Blocks release of CGRP Increase in headache, Nausea, Chest pressure, Fatigue
Combination sumatriptan and naproxen Suvexxl The combination of sumatriptan and naproxen allows to take one tablet instead of two Side effects of sumatriptan and naproxen may occur
DHE Dihydroergotamine Migranal
DHE vial for injection		 Act on the serotonin system Nausea Cramps Hypertension
Combinations Mix of acetaminophen, NSAID, caffeine, codeine, barbiturates Excedrin, Fiorinal, Tylenol 1-2-3 Depends on content Depends on content. High risk of medication overuse headache.
Opioids Morphine, Codeine, Hydromorphone, Oxycodone, Meperidine Statex, Codeine, Dilaudid, Supeudol, Demerol Act on opioid receptors in the pain networks Nausea, Sleepiness, Constipation. High risk of medication overuse headache, Addiction.
Anti-nausea Dimenhydrinate, Metoclopramide, Prochlorperazine Gravol, Maxeran, Stemetil Anti-histamine, Anti-dopamine Somnolence, Restlessness, Distonic reactions
Steroids Dexamethasone, Prednisone Decadron Act on steroid receptors Insomnia, hypertension, fluid retention

** Cannabinoids are not listed as there is currently no evidence of their effect to treat migraine attacks (See this post). More research is needed. 

** Neuromodulation devices can be used to treat migraine attacks and are reviewed in another section.

** New molecules not yet available in Canada like gepants and ditans will be discussed in the future. 

 

REFERENCES

Mayans L, Walling A. Acute Migraine Headache: Treatment Strategies. Am Fam Physician. 2018;97(4):243-51.

Worthington I, Pringsheim T, Gawel MJ, Gladstone J, Cooper P, Dilli E, et al. Canadian Headache Society Guideline: acute drug therapy for migraine headache. Can J Neurol Sci. 2013;40(5 Suppl 3):S1-s80.

Post#814

Print This Post Print This Post