Acute Migraine Treatments
NHS Tayside RefGuide
Warning
1st line/OTC treatments
- Aspirin 600-900mg up to 4 doses in 24 hours
- Ibuprofen 400-600mg up to 4 doses in 24 hours
- Paracetamol 1g up to 4 doses in 24 hours (500mg if weight less than 50kg) if mild / moderate or unable to tolerate NSAIDs.
Anti-emetics*
Anti-emetics may aid absorption of acute treatments, please consider even in absence of nausea.
- Domperidone or Prochlorperazine
Second line/triptans
If patient fails to respond please consider trial of a different triptan/or a different route.
Formulary choices:
- Eletriptan 40mg
- Zolmatriptan 5mg or 5mg
- Rizatriptan 10mg
- Sumatriptan oral 50mg or 100mg (use 100mg if 50mg ineffective) or Sumatriptan injection 6mg
Triptan non-responders1/ contraindications
1Non-response = inadequate relief to trials of at least 2 triptans with appropriate timing (take triptan early in headache), correct route of administration and combination treatment has been considered.
- Rimegepant 75mg taken as a once off dose
*anti-emetics may aid absorption of acute treatments, please consider even in absence of nausea
Further information
National Headache Pathway - Acute Treatment of Migraine in Primary Care