A neurologists guide to acute migraine therapy in the. Preventive treatments include medicines, behavioral therapy, or physical therapy. Acute treatment of migraine includes the use of drug therapy and behavioural techniques. Ineffective acute treatment of episodic migraine is. Feb 15, 2018 migraine is a primary headache disorder characterized by recurrent attacks. Acute treatment and prevention of menstrually related. Dihydroergotamine dhe is also suitable for selected patients. There are two main treatment approaches abortive and preventive. What do we hope to accomplish with acute treatment of migraine. Please discuss the currently available treatment options with your migraine specialist. Triptans are the firstline medications for acute migraine treatment.
Patients who have failed acetaminophen and nsaids should be offered triptans for acute migraine treatment. Feb 17, 2015 to test the hypothesis that ineffective acute treatment of episodic migraine em is associated with an increased risk for the subsequent onset of chronic migraine cm. Becker, on behalf of the canadian headache society acute migraine treatment guideline development group. Also known as acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop symptoms. Migraine headaches management and treatment cleveland clinic. Treatment guidelines for acute and preventive treatment of. Developing drugs for acute treatement guidance for. Pharmacologic treatment of migraine headache in children and adolescents from american academy of neurology aan and child neurology society, 2004. This guidance ad dresses the development of drugs for the acute. The choice of treatment for acute migraine should be guided by the patients preference, response to previous treatment, the. The acute treatment drugs for migraine generally include 1 acetaminophens, 2 nonsteroidal.
Silberstein jefferson headache center, philadelphia, pennsylvania, usa migraine varies in its frequency, severity, and impact. Pharmacologic acute and preventive treatment for migraine in. Another potential new acute treatment for migraine is lasmiditan, a selective 5ht 1f agonist. The american headache society evidence assessment of migraine pharmacotherapies. Triptans can be used in combination with nsaids or acetaminophen. Discuss the evidence and guidelines supporting the major migraine acute treatment options 3.
Migraine headache acute treatment of migraine in primary care the choice of acute migraine treatments should be dictated by the rapidity of onset, headache severity, associated symptoms e. Long term frequent use of acute abortive treatment may transform the migraine. A migraine usually starts gradually and then becomes more severe. This is why physicians work with their migraine patients in teaching them to treat earlier in the course of the attack, and if possible, treat when pain is mild.
An acute headache is pain or discomfort that starts suddenly and gets worse quickly. In the american migraine prevalence and prevention study, respondents with em in 2006. Adult patients were randomized and given either 6 mg of sumatriptan succinate subcutaneously n 734 or placebo n. Other acute headache pain can happen every day, and sometimes several times a day. Acute treatment, migraine attacks withwithout aura adults acute treatment, migraine headaches pediatrics acute treatment, cluster headache episodes adults dosage and administration scheduleb max dose24 hours. Two parallelgroup trials for treatment of acute migraines were conducted in the united states.
General recommendations for the treatment of acute migraine include the following 1,2 0educate migraine sufferers about their condition and its treatment and. First, opioids are not as effective in the treatment of acute migraine as other agents, such as dihydroergotamine dhe, 22 ketorolac, 22 butyrophenones, and the phenothiazines with more side. Dosing of medications for acute migraine, and estimation of their efficacy based on. Family history of migraine is present in 7080% of sufferers.
Narcotics and habituating medications should be avoided in the acute treatment of migraine, as the risk for transformation to chronic daily headache is excessively high at a relatively infrequent. The criteria used to determine the categorization of the recommendations do, do not do, and do not know are defined at the end of the major recommendations field. Limitation of dosage allowance per week to prevent toxicity the efficacy of these drugs decreases when administered after the onset of the headache physiological changes, nonspecific disabling symptoms may occur during the migraine free periods in chronic migraine. Acute treatment is initiated during an attack to relieve pain and disability and to stop progression of the attack. This is a summary of the american academy of neurology aan and american headache society ahs practice guideline update, acute treatment of migraine in children and adolescents, which was published in neurology online on august 14, 2019, and appears in the september 10, 2019, print issue. Compared to nonmenstrual migraine, mrm attacks are more severe, longer in duration, and have a poorer response to analgesics. Migraine headache is a common and potentially debilitating disorder often treated by family physicians. Abortive medications are most effective when used at the first sign of a migraine. Efficacy of adam zolmitriptan for the acute treatment of. Guideline for primary care management of headaches in adults. Migraine treatment summary bnf content published by nice. In all cases of migraine, the use of acute pain therapies must be watched closely so that a patient does not develop medication overuse headache.
Acute treatment of migraine attacks during pregnancy, lactation, and for patients with chronic migraine is also discussed. The choice of treatment for acute migraine should be guided by the patients preference, response to previous treatment, the severity and frequency of headache attacks, other associated symptoms, and comorbidities. In addition, an explanation of the evidence source i. Gawel, jonathan gladstone, paul cooper, esma dilli. Potential treatments for acute migraine in the emergency room setting. In chronic migraine, it is particularly important that medication overuse is eliminated or avoided. Nociceptionspecific stimulation revealed a shortening of r2 onset latencies 44. A standardized literature search was performed to identify articles related to acute migraine treatment that were published between 1998 and 20. Acute treatment, migraine attacks withwithout aura adults acute treatment, migraine headaches pediatrics acute treatment, cluster headache episodes adults dosage and administration. Migraine headaches are three times more common in women than in men.
Several general principles improve outcomes for acute treatment, including giving acute medication early while pain is. It also provides a clear understanding of the adverse events associated with various agents. Many medications have been designed to treat migraines. First, opioids are not as effective in the treatment of acute migraine as other agents, such as dihydroergotamine dhe, 22 ketorolac, 22 butyrophenones, and the phenothiazines with more side effects. Primary headache disorders, such as migraine and cluster headache, are the most common reasons, for which patients seek neurologic advice, and every year affect nearly 3 billion. Intravenous metoclopramide and prochlorperazine, and subcutaneous sumatriptan should be offered to eligible adults who present to an ed with acute migraine. In addition, opioids have the potential to promote chronic migraine 25 and probably medication overuse headache. Medications used to combat migraines fall into two broad categories.
It typically causes throbbing or pulsing pain, which is often on one side of your head. Endorsed by the american osteopathic association and by the international headache society. Migraine headache medications, symptoms, causes, treatment. Treatment strategies laura mayans, md, mph, and anne walling, mb, chb university of kansas school of medicine, wichita.
Sumatriptan succinate, a 5ht1d receptor agonist, constricts human cranial arteries. Emgality is not approved for the acute treatment of migraine if you have 4 or more migraine headache days a month, ask your doctor if a migraine preventive treatment like oncemonthly emgality is right for you. Guideline for primary care management of headache in. Migraine pharmacologic treatment may be acute abortiveor preventive prophylactic, and. These types of drugs are taken regularly, often daily, to reduce the severity or frequency of migraines. Recent advances in migraine therapy migraine headache. Guidelines of the international headache society for. The optimal acute treatment of migraine requires recognition of the multitude of migraine presentations, the frequency of total attacks, and number of days of headache disability. Migraine treatment is complex, and treatment must be individualized and tailored to the patients clinical features. Introduction migraine is a common episodic disorder, the hallmark of which is a disabling headache generally associated with nausea, andor light and sound sensitivity. Cgrp can trigger acute headache and delayed migrainelike attacks. Primary headache disorders neurology clinical practice. Apr 22, 2008 compared to nonmenstrual migraine, mrm attacks are more severe, longer in duration, and have a poorer response to analgesics.
Feb 03, 2020 an acute headache is pain or discomfort that starts suddenly and gets worse quickly. Cgrp can trigger acute headache and delayed migraine like attacks. What are the acute treatments for migraine and how are they used. Guideline for primary care management of headache in adults. Apr 15, 2015 acute treatment of migraine attacks during pregnancy, lactation, and for patients with chronic migraine is also discussed.
Best practice suggests that acute migraine treatment should be stratified based on the severity of the individual event, with a goal of returning the. Approximately 40 million adults 1215% in the united states. Draft evidence report acute treatments for migraine return to table of contents 1. A 8 abortive therapy should be used as early as possible in the course of a migraine. You may have an acute headache only when you feel stress or eat certain foods.
A neurologists guide to acute migraine therapy in the emergency. Effective acute treatment of headache begins with making an accurate diagnosis and ruling out secondary causes of headache. Treatment guideline subcommittee of the taiwan headache society abstractthe treatment guideline subcommittee of the taiwan headache society evaluated both the acute and the preventive treatments for cluster headache now being used in taiwan, based on the principles of evidencebased medicine. In chronic migraine, it is particularly important that medication. The purpose of this guideline is to provide a systematic. If a patient doesnt respond to 12 adequate doses of a. B 19 combination analgesics containing aspirin, caffeine, and acetaminophen are an effective firstline abortive treatment for migraine. Sign 155 pharmacological management of migraine scottish.
Gawel, jonathan gladstone, paul cooper, esma dilli, michel aube, elizabeth leroux, werner j. To test the hypothesis that ineffective acute treatment of episodic migraine em is associated with an increased risk for the subsequent onset of chronic migraine cm. Patients who have failed acetaminophen and nsaids should be offered triptans for acute. Use of narcotic analgesics in the emergency department treatment of migraine headache. Guideline titles acute treatment of migraine in children and adolescents 1 and pharmacologic treatment for pediatric migraine prevention 2.
Preventive treatments are used proactively to help reduce the number of migraine days. Many women experience migraines related to the hormonal changes of menstruation, oral contraceptives, pregnancy, postpartum and menopause. In addition, they will often have side effects or contraindications for use in the presence of other medical conditions. There are new therapies on the horizon for both acute and preventative treatment of patients with migraine. The treatment of chronic migraine should focus on preventive therapy while avoiding migraine triggers and limiting the use of acute headache medications to avoid medication overuse headache. Pharmacologic acute and preventive treatment for migraine. The criteria used to determine the categorization of the recommendations do, do not do, and do not know are defined at the end of. Treatment of acute migraine with subcutaneous sumatriptan. Learn more about an acute treatment that could fit into your treatment plan.
Maxmaximum all products in the above chart are indicated for the acute treatment of migraine attacks with or. Aan practice guideline summary for clinicians practice. The role of headacherelated disability in migraine management. Once a primary headache is diagnosed, it is important to choose the. Clinical trials for the acute treatment of migraine attacks 1. Acute migraine treatment american headache society. Preventive treatment of migraine in adults is discussed separately. Migraine is a primary headache disorder characterized by recurrent attacks. Apr 23, 2002 nociceptionspecific stimulation revealed a shortening of r2 onset latencies 44.
Medications for acute migraine treatment volume 40 supplement irene worthington, tamara pringsheim, marek j. Too frequent use of many of the medications used to treat. Acute migraine treatment in adults becker 2015 headache. But sometimes you can have a migraine without a headache. List all important options in the acute treatment of migraine 2. There are new therapies on the horizon for both acute and preventative. Pharmacologic management of acute attacks of migraine and.
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