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 | |
Analgesics | Acetaminophen Paracetamol |
Tylenol | Probably block inflammation | Usually, well-tolerated Overdose may lead to death Overuse may lead to more headaches |
NSAIDs | Ibuprofen Diclofenac Ketorolac Naproxen ASA |
Advil, Motrin Cambia, Voltaren Toradol Aleve Aspirin |
Block COX enzyme, decrease prostaglandins = less inflammation | Stomach irritation, and, ulcers High blood pressure Small risk of heart disease |
Triptans | Almotriptan Eletriptan Frovatriptan Naratriptan Rizatriptan Sumatripan 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 |
Triptan/NSAID combination
DHE |
sumatriptan and naproxen
Dihydro |
Suvexxl
Migranal |
Combined mechanism: Act on the serotonin system (stimulates 5HT 1b-d receptors) Blocks release of CGRP (triptan)
Act on the serotonin system |
Stomach irritation and ulcers
Nausea
|
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 |
Sleepiness Restlessness Muscle spasms |
Steroids | Dexamethasone Prednisone | Decadron | Act on steroid receptors | Insomnia, high blood pressure, 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
Tags In
Categories
THE MIGRAINE TREE
- BRANCHES
- ACUTE TREATMENTS
- DEVICES AND NEUROMULATIOIN
- PREVENTIVE TREATMENTS
- PROCEDURES AND INJECTIONS
- SELF-CARE AND LIFESTYLE
- SOCIAL LIFE
- TRUNK
- ROOTS
OTHER CATEGORIES