Abstract
All patients with migraine need to be provided acute treatment, even those on preventive medications. Setting clinical goals and expectations with patients improves adherence and outcomes. Goals for acute treatment include quick onset with consistent response, low recurrence, restoration of normal function with reduced disability, minimal side effects, and minimal use of rescue medications, at the lowest possible cost. When patients are surveyed as to their desires for acute treatment and given choices, they choose a pain-free response by 2 h.
Clinical pearls for acute treatment are provided, followed by specific sections on use of triptans, ergots, nonsteroidal anti-inflammatory drugs (NSAIDs), and other nonspecific medications such as acetaminophen, butalbital, antiemetics, steroids, and narcotics. Special sections discuss the potential for drug–drug interactions, including serotonin syndrome, as well as emergency acute treatment.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Suggested Reading
Bigal ME, Serrano D, Buse D, Scher A, Stewart WF, Lipton, RB. Acute Migraine Medications and Evolution from Episodic to Chronic Migraine: A Longitudinal Population Based Study. Headache. 2008;48:1157–1168.
Cameron JD, Lane PL, Speechley M. Intravenous chlorpromazine vs intravenous metoclopramide in acute migraine headache. Acad Emerg Med. 1995;2:597.
Colman I, Brown MD, Innes GD, Grafstein E, Roberts TE, Rowe BH. Parenteral metoclopramide for acute migraine: meta-analysis of randomized controlled trials. BMJ. 2004;329:1369.
Coxib and traditional NSAID Trialists’ (CNT) Collaboration. Vascular and upper gastrointestinal effects of non-steroidal anti-inflmamatory drugs: meta-analyses of individual participant data from randomized trial. Lancet. 2013;382:769–779.
Evans RW, Tepper SJ, Shapiro RE, Sun-Edelstein C, Tiejtjen GE. The FDA alert on Serotonin Syndrome with use of Triptans combined with Selective Serotonin Reuptake Inhibitors or Selective Serotonin-Norepinephrine Reuptake Inhibitors: American Headache Society Position Paper. Headache. 2010;50:1089–1099.
Friedman BW, Greenwald P, Bania TC, Esses D, Hochberg M, Solorzano C, Corbo J, Chu J, Chew E, Cheung P, Fearon S, Paternoster J, Baccellieri A, Clark S, Bijur PE, Lipton RB, Gallagher EJ. Randomized trial of IV dexamethasone for acute migraine in the emergency department. Neurology. 2007;69:2038–2044.
Goadsby PJ, Lipton RB, Ferrai MD. Drug Therapy: Migraine-current understanding and treatment. N Engl J Med. 2002;346:257–270.
Kelley NE, Tepper DE. Rescue therapy for acute migraine, part 1: triptans, dihydroergotamine, and magnesium. Headache. 2012;52(1):114–128.
Kelley NE, Tepper DE. Rescue therapy for acute migraine, part 2: neuroleptics, antihistamines, and others. Headache. 2012;52(2):292–306. Erratum in: Headache. 2012;52(3):527.
Kelley NE, Tepper DE. Rescue therapy for acute migraine, part 3: opioids, NSAIDs, steroids, and post-discharge medications. Headache. 2012;52(3):467–482.
Leinisch E, Evers S, Kaempfe N, Kraemer C, Sostak P, Jürgens T, Straube A, May A. Evaluation of the efficacy of intravenous acetaminophen in the treatment of acute migraineattacks: a double-blind, placebo-controlled parallel group multicenter study. Pain. 2005;117:396–400.
Lipton RB, Stewart WF. Acute migraine therapy: do doctors understand what patients with migraine want from therapy? Headache. 1999;39(Suppl 2):20–26.
Lipton RB, Baggish JS, Stewart WF, Codispoti JR, Fu M. Efficacy and safety of acetaminophen in the treatment of migraine. Results of a randomized, double-blind placebo-controlled, population-based study. Arch Intern Med. 2000;160:3486.
Tepper DE. Should butalbital ever be given, much less to a pregnant woman? Headache. 2014;54(1):10–11.
Tepper SJ. Acute treatment of Migraine. Continuum. 2003;87–105.
US Headache Consortium. Evidence Based guidelines for migraine headache. www.aan.com. 2000.
Worthington I, Pringsheim T, Gawel MJ, Gladstone J, Cooper P, Dilli E, Aube M, Leroux E, Becker WJ, Canadian Headache Society Acute Migraine Treatment Guideline Development Group. Canadian Headache Society Guideline: acute drug therapy for migraine headache. Can J Neurol Sci. 2013;40(5 Suppl 3):S1–S80.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Kriegler, J. (2014). Acute Treatment of Episodic Migraine. In: Tepper, S., Tepper, D. (eds) The Cleveland Clinic Manual of Headache Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-04072-1_10
Download citation
DOI: https://doi.org/10.1007/978-3-319-04072-1_10
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-04071-4
Online ISBN: 978-3-319-04072-1
eBook Packages: MedicineMedicine (R0)