Acute Migraine Treatment

Abstract

PURPOSE OF REVIEWMigraine is a disabling disease of attacks of moderate to severe pain with associated symptoms. Every person with migraine requires treatment for acute attacks. Treatments can range from behavioral management and nonspecific medications to migraine-specific medications and neuromodulation. For many with migraine, having a combination of tools allows for effective treatment of all types of attacks.RECENT FINDINGSOver the past several years, four neuromodulation devices have been cleared by the US Food and Drug Administration (FDA) for treatment of acute migraine, and three medications with novel mechanisms of action have been FDA approved. They add to the arsenal available to people with migraine and focus on migraine-specific pathways to allow for precise care with fewer side effects.SUMMARYThis article discusses acute migraine therapy, focusing on best-level evidence.

Treating acute migraine with ubrogepant

“…9 Because of lasmiditan's adverse reaction profile, the FDA has issued a safety warning advising against its use within 8 hours of operating any motor vehicle. 3 Lasmiditan is a Schedule V controlled substance because of its possible abuse potential. 3 Avoid this drug in patients with severe liver disease and in children and pregnant patients.…”

“…3 Lasmiditan is a Schedule V controlled substance because of its possible abuse potential. 3 Avoid this drug in patients with severe liver disease and in children and pregnant patients. 9 Lasmiditan is not as effective as triptans are but could be used as an alternative for patients with vascular risk factors.…”

“…Acetaminophen and NSAIDs are the most common medications used by patients to manage acute migraines before seeing a healthcare provider. 3 Both are the first-line treatment for mild to moderate migraines. 1 In a 2015 metaanalysis, Cameron and colleagues found that 46% to 52% of patients had favorable outcomes with acetaminophen, NSAIDs, and aspirin for management of acute migraine.…”

“…Like triptans, dihydroergotamine is contraindicated in patients with cardiovascular disease and risk factors. 3…”

“…Evidence indicates that opioids and butalbital-containing products may cause more harm than benefit for acute migraine treatment. 3 Data from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study in 2020 showed that 36.3% of participants were using or kept opioids on hand to treat their headaches. 5 Compared with patients with migraines who do not use opioids, those who used opioids had increased rates of depression and anxiety and increased frequency and severity of headaches.…”