Migraine: Acute Management & Complimentary therapies

Drugs for use in the Acute Management

Drug	Dose	Remarks
Analgesics	Oral	Use should be restricted to three headaches/week to prevent analgesic rebound headache
Acetaminophen	15mg/kg/dose q4-6hrly
Ibuprofen	10mg/kg/dose q6hrly
Naproxen sodium	5-7mg/kg q8-12hrly
Triptans (5-HT1 receptor agonists)	Oral, Subcutaneous and Intranasal	Restrict uses to 6 headaches/monthContraindicated in cerebrovascular disease, uncontrolled hypertension, basilar migraine, hypersensitivity reaction
Rizatriptan	Route: oral Dose: 5-10mg at onset; may repeat in 2 hr; not to exceed 30mg/24h	US FDA approved in Children aged 6-17 years
Almotriptan	Route: oral Dose: 6.25-12.5mg at onset; may repeat in 2 hr; no more than 2 doses in 24 h	Approved for children >12 years age
Sumatriptan	Oral: 25,50,100 mg at onset; may repeat in 2 h, up to 100mgSC: 6mg at onset, may repeat dose in 1 hr, upto 12mg/dIN: 20mg, one spray in one nostril at onset; may repeat 2-24 hr; limit to 2 spray/24 h	Safety and efficacy demonstrated in controlled trials in adolescents but not US FDA approved
Zolmitriptan	Oral, IN: 2.5-5mg at onset; may repeat in 2 h; not to exceed 10mg/24h	Safety and efficacy demonstrated in controlled trials in adolescents but not US FDA approved

It is advisable to prevent overuse of analgesics to prevent chronic and intractable headaches termed analgesic rebound headache. In case the patient still has prolonged headache inspite of use of NSAID, a triptan should be introduced to manage headache. It is important to start treatment of the migraine component of the headache as soon as it starts, using an appropriate medication at an adequate dose. The goal is to abort the headache within 1-2 hours.

Rehydration with fluids during the period of acute headache is an additional measure to abort the headache

Complementary Therapy options for Migraine include: