Clinical Stratification of Acute Specific Migraine Treatments
Clinical Situation | Treatment Options |
---|---|
Failed NSAIDs/analgesics | First tier |
Sumatriptan 50 or 100 mg PO | |
Almotriptan 12.5 mg PO | |
Rizatriptan 10 mg PO | |
Eletriptan 40 mg PO | |
Zolmitriptan 2.5 mg PO | |
Slower effect/better tolerability | |
Naratriptan 2.5 mg PO | |
Frovatriptan 2.5 mg PO | |
Infrequent headache | |
Ergotamine/caffeine 1-2/100 mg PO | |
Dihydroergotamine nasal spray 2 mg | |
Early nausea or difficulties taking tablets | Zolmitriptan 5-mg nasal spray Sumatriptan 20-mg nasal spray Rizatriptan 10-mg MLT wafer |
Headache recurrence | Ergotamine 2 mg (most effective PR/usually with caffeine) |
Naratriptan 2.5 mg PO | |
Almotriptan 12.5 mg PO | |
Eletriptan 40 mg | |
Tolerating acute treatments poorly | Naratriptan 2.5 mg Almotriptan 12.5 mg |
Early vomiting | Zolmitriptan 5-mg nasal spray |
Sumatriptan 25 mg PR | |
Sumatriptan 6 mg SC | |
Menses-related headache | Prevention |
Ergotamine PO at night | |
Estrogen patches | |
Treatment | |
Triptans | |
Dihydroergotamine nasal spray | |
Very rapidly developing symptoms | Zolmitriptan 5-mg nasal spray Sumatriptan 6 mg SC Dihydroergotamine 1 mg IM |