Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Apr 1;30(2):344-363.
doi: 10.1212/CON.0000000000001402.

Acute Treatment of Migraine

Rebecca Burch
Review

Acute Treatment of Migraine

Rebecca Burch. Continuum (Minneap Minn). .

Abstract

Objective: Most patients with migraine require acute treatment for at least some attacks. This article reviews the approach to the acute treatment of migraine, migraine-specific and nonspecific treatment options, rescue treatment and options for management in the emergency department and inpatient settings, and treatment during pregnancy and lactation.

Latest developments: Triptans, ergot derivatives, and nonsteroidal anti-inflammatory drugs have historically been the main acute treatments for migraine. The development of new classes of acute treatment, including the small-molecule calcitonin gene-related peptide receptor antagonists (gepants) and a 5-HT1F receptor agonist (lasmiditan), expands available options. These new treatments have not been associated with vasospasm or increased cardiovascular risk, therefore allowing migraine-specific acute treatment for the more than 20% of adults with migraine who are at increased risk of cardiovascular events. Neuromodulation offers a nonpharmacologic option for acute treatment, with the strongest evidence for remote electrical neuromodulation.

Essential points: The number of available migraine treatments continues to expand, although triptans are still the mainstay of migraine-specific acute treatment. There is no one-size-fits-all acute treatment and multiple treatment trials are sometimes necessary to determine the optimal regimen for patients. Switching within and between classes, using the maximum allowed dose, using combination therapy, and counseling patients to treat early are all strategies that may improve patient response to acute treatment.

PubMed Disclaimer

References

    1. Silberstein SD. Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2000;55(6):754–762. doi:10.1212/wnl.55.6.754 - DOI
    1. Lipton RB, Fanning KM, Serrano D, et al. Ineffective acute treatment of episodic migraine is associated with new-onset chronic migraine. Neurology 2015;84(7):688–695. doi:10.1212/WNL.0000000000001256 - DOI
    1. Lipton RB, Hamelsky SW, Dayno JM. What do patients with migraine want from acute migraine treatment? Headache 2002;42 Suppl 1:3–9. doi:10.1046/j.1526-4610.2002.0420s1003.x - DOI
    1. Ferrari MD, Goadsby PJ, Roon KI, Lipton RB. Triptans (serotonin, 5-HT1B/1D agonists) in migraine: detailed results and methods of a meta-analysis of 53 trials. Cephalalgia Int J Headache 2002;22(8):633–658. doi:10.1046/j.1468-2982.2002.00404.x - DOI
    1. Goadsby PJ, Zanchin G, Geraud G, et al. Early vs. non-early intervention in acute migraine-’Act when Mild (AwM)’. A double-blind, placebo-controlled trial of almotriptan. Cephalalgia Int J Headache 2008;28(4):383–391. doi:10.1111/j.1468-2982.2008.01546.x - DOI

Substances

LinkOut - more resources