Options to treat the migraine attack the Ultimate Table and Key Tips
Key Concepts for acute treatment:
- The goal is to return to function or at least decrease symptoms
- Try different options with your healthcare provider
- Record results in your diary
- Treat early, it will increase your success rate
- Combine NSAID + triptan if severe attacks
- If you have nausea, use specific medications for it
- Use other options than pills for severe attacks (nasal sprays, injections, etc.)
- May use different options for attacks of different severity
- Avoid overuse, if you are at risk consider prevention
- Avoid opioids, they should be only a last resort
|Medication||Brand names||How they work||Side effects|
|Tylenol||Probably block inflammation||Usually, well-tolerated Overdose may lead to death Overuse may lead to more headaches|
|Block COX enzyme, decrease prostaglandins = less inflammation||Stomach irritation, and, ulcers High blood pressure Small risk of heart disease|
|Act on the serotonin system (stimulates 5HT 1b-d receptors) Blocks release of CGRP||Increase in headache Nausea Chest pressure Fatigue|
sumatriptan and naproxen
Act on the serotonin system (stimulates 5HT 1b-d receptors) Blocks release of CGRP (triptan)
Act on the serotonin system
Stomach irritation and ulcers
|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
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
|Sleepiness Restlessness Muscle spasms|
|Steroids||Dexamethasone Prednisone||Decadron||Act on steroid receptors||Insomnia, high blood pressure,
** 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.
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.
THE MIGRAINE TREE
- ACUTE TREATMENTS
- DEVICES AND NEUROMULATIOIN
- PREVENTIVE TREATMENTS
- PROCEDURES AND INJECTIONS
- SELF-CARE AND LIFESTYLE
- SOCIAL LIFE