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Table 49-4

Treatment of Acute Migraine

DrugTrade NameDosage
Simple Analgesics
Acetaminophen, aspirin, caffeine Excedrin MigraineTwo tablets or caplets q6h (max eight per day)
NSAIDs
NaproxenAleve, Anaprox, generic220-550 mg PO bid
IbuprofenAdvil, Motrin, Nuprin, generic400 mg PO q3-4h
Tolfenamic acidClotam Rapid200 mg PO; may repeat ×1 after 1-2 h
Diclofenac KCambia50 mg PO with water
5-HT1 Receptor Agonists
Oral
Ergotamine 1 mg, caffeine 100 mgCafergotOne or two tablets at onset, then one tablet q½h (max 6 per day, 10 per week)
NaratriptanAmerge2.5-mg tablet at onset; may repeat once after 4 h
RizatriptanMaxalt5- to 10-mg tablet at onset; may repeat after 2 h (max 30 mg/d)
Maxalt-MLT
SumatriptanImitrex50- to 100-mg tablet at onset; may repeat after 2 h (max 200 mg/d)
FrovatriptanFrova2.5-mg tablet at onset, may repeat after 2 h (max 5 mg/d)
AlmotriptanAxert12.5-mg tablet at onset, may repeat after 2 h (max 25 mg/d)
EletriptanRelpax40 or 80 mg
ZolmitriptanZomig2.5-mg tablet at onset; may repeat after 2 h (max 10 mg/d)
Zomig Rapimelt
Nasal
DihydroergotamineMigranal Nasal SprayPrior to nasal spray, the pump must be primed four times; one spray (0.5 mg) is administered, followed in 15 min by a second spray
SumatriptanImitrex Nasal Spray5- to 20-mg intranasal spray as four sprays of 5 mg or a single 20-mg spray (may repeat once after 2 h, not to exceed a dose of 40 mg/d)
ZolmitriptanZomig5-mg intranasal spray as one spray (may repeat once after 2 h, not to exceed a dose of 10 mg/d)
Parenteral
DihydroergotamineDHE-451 mg IV, IM, or SC at onset and q1h (max 3 mg/d, 6 mg per week)
Sumatriptan

Imitrex Injection

Alsuma

Sumavel DosePro

6 mg SC at onset (may repeat once after 1 h for max of two doses in 24 h)
Dopamine Receptor Antagonists
Oral
MetoclopramideReglan,a generica5-10 mg/d
ProchlorperazineCompazine,a generica1-25 mg/d
Parenteral
ChlorpromazineGenerica0.1 mg/kg IV at 2 mg/min; max 35 mg/d
MetoclopramideReglan,a generic10 mg IV
ProchlorperazineCompazine,a generica10 mg IV
Other
Oral
Acetaminophen, 325 mg, plus dichloralphenazone, 100 mg, plus isometheptene, 65 mgMidrin, genericTwo capsules at onset followed by one capsule q1h (max five capsules)
Nasal
ButorphanolGeneric1 mg (one spray in one nostril), may repeat if necessary in 1-2 h
Parenteral
OpioidsGenericaMultiple preparations and dosages; see Table 5-2.

aNot all drugs are specifically indicated by the FDA for migraine. Local regulations and guidelines should be consulted.

Note: Antiemetics (e.g., domperidone 10 mg or ondansetron 4 or 8 mg) or prokinetics (e.g., metoclopramide 10 mg) are sometimes useful adjuncts.

Abbreviations: 5-HT, 5-hydroxytryptamine.