Table 3 Acute migraine treatment
Drug class | Drug | Dosage and route | Contraindications |
|---|---|---|---|
First-line medication | |||
NSAIDs | Acetylsalicylic acid | 900–1,000 mg oral | Gastrointestinal bleeding, heart failure |
Ibuprofen | 400–600 mg oral | ||
Diclofenac potassium | 50 mg oral (soluble) | ||
Other simple analgesics (if NSAIDs are contraindicated) | Paracetamol | 1,000 mg oral | Hepatic disease, renal failure |
Antiemetics (when necessary) | Domperidone | 10 mg oral or suppository | Gastrointestinal bleeding, epilepsy, renal failure, cardiac arrhythmia |
Metoclopramide | 10 mg oral | Parkinson disease, epilepsy, mechanical ileus | |
Second-line medication | |||
Triptans | Sumatriptan | 50 or 100 mg oral or 6 mg subcutaneous or 10 or 20 mg intranasal | Cardiovascular or cerebrovascular disease, uncontrolled hypertension, hemiplegic migraine, migraine with brainstem aura |
Zolmitriptan | 2.5 or 5 mg oral or 5 mg intranasal | ||
Almotriptan | 12.5 mg oral | ||
Eletriptan | 20, 40 or 80 mg oral | ||
Frovatriptan | 2.5 mg oral | ||
Naratriptan | 2.5 mg oral | ||
Rizatriptan | 10 mg oral tablet (5 mg if treated with propranolol) or 10 mg mouth-dispersible wafers | ||
Third-line medication | |||
Gepants | Ubrogepant | 50, 100 mg oral | Co-administration with strong CYP3A4 inhibitors |
Rimegepant | 75 mg oral | Hypersensitivity, hepatic impairment | |
Ditans | Lasmiditan | 50, 100 or 200 mg oral | Pregnancy, concomitant use with drugs that are P-glycoprotein substrates |
