Migraine Acute Treatment

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:

Almotriptan 12.5mg
Zolmatriptan 2.5mg or 5mg
Rizatriptan 10mg
Sumatriptan oral 50mg or 100mg (use 100mg if 50mg ineffective) or Sumatriptan injection 6mg.

Triptan non-responders/ contraindications

Non-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

Further Information

National Headache Pathway - Acute Treatment of Migraine in Primary Care