Treatment of Acute Migraine | ||
| DRUG | TRADE NAME | DOSAGE |
|---|---|---|
| Simple analgesics | ||
| Acetaminophen, aspirin, caffeine | Excedrin Migraine | 2 tablets or caplets q6h (max 8 per day) |
| NSAIDs | ||
| Naproxen | Aleve, Anaprox, generic | 220-550 mg PO bid |
| Ibuprofen | Advil, Motrin, Nuprin, generic | 400 mg PO q3-4h |
| Tolfenamic acid | Clotam Rapid | 200 mg PO; may repeat ×1 after 1-2 h |
| Diclofenac K | Cambia | 50 mg PO with water |
| 5-HT1B/1D receptor agonists | ||
| Oral | ||
| Ergotamine 1 mg, caffeine 100 mg | Cafergot | 1 or 2 tablets at onset, then one tablet q½h (max 6 per day, 10 per week) |
| Naratriptan | Amerge | 2.5-mg tablet at onset; may repeat once after 4 h |
| Rizatriptan | Maxalt-MLT | 5-10-mg tablet at onset; may repeat after 2 h (max 30 mg/d) |
| Sumatriptan | Imitrex | 50-100-mg tablet at onset; may repeat after 2 h (max 200 mg/d) |
| Frovatriptan | Frova | 2.5-mg tablet at onset, may repeat after 2 h (max 5 mg/d) |
| Almotriptan | Axert | 12.5-mg tablet at onset, may repeat after 2 h (max 25 mg/d) |
| Eletriptan | Relpax | 40 or 80 mg |
| Zolmitriptan | Zomig Rapimelt | 2.5-mg tablet at onset; may repeat after 2 h (max 10 mg/d) |
| Nasal | ||
| Dihydroergotamine | Migranal Nasal Spray | Prior to nasal spray, the pump must be primed 4 times; 1 spray (0.5 mg) is administered, followed in 15 min by a second spray |
| Sumatriptan | Imitrex Nasal Spray | 5-20 mg intranasal spray as 4 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) |
| Zolmitriptan | Zomig | 5 mg intranasal spray as one spray (may repeat once after 2 h, not to exceed a dose of 10 mg/d) |
| Parenteral | ||
| Dihydroergotamine | DHE-45 | 1 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 2 doses in 24 h) |
| Dopamine receptor antagonists | ||
| Oral | ||
| Metoclopramide | Reglan,a generica | 5-10 mg/d |
| Prochlorperazine | Compazine,a generica | 1-25 mg/d |
| Parenteral | ||
| Chlorpromazine | Generica | 0.1 mg/kg IV at 2 mg/min; max 35 mg/d |
| Metoclopramide | Reglan,a generic | 10 mg IV |
| Prochlorperazine | Compazine,a generica | 10 mg IV |
| Other | ||
| Oral | ||
| Acetaminophen, 325 mg, plus dichloralphenazone, 100 mg, plus isometheptene, 65 mg | Midrin, generic | Two capsules at onset followed by 1 capsule q1h (max 5 capsules) |
| Parenteral | ||
Opioids | Generica | Multiple preparations and dosages; see Table 6-2 Drugs for Relief of Pain |
Other | ||
Noninvasive Vagus Nerve Stimulation (nVNS) Single pulse transcranial magnetic stimulation (sTMS) | SpringTMS gammaCore | Two pulses at onset followed by two further pulses Two doses each of 120 seconds |
a Not 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; NSAIDs, nonsteroidal anti-inflammatory drugs.