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Table 49-5

Clinical Stratification of Acute Specific Migraine Treatments

Clinical SituationTreatment Options
Failed NSAIDs/analgesicsFirst 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 recurrenceErgotamine 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 vomitingZolmitriptan 5-mg nasal spray
Sumatriptan 25 mg PR
Sumatriptan 6 mg SC
Menses-related headachePrevention
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