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 |