Migraine Treatment Guidelines

First-Line Treatment Options

The American Academy of Family Physicians recommends triptans as the first-line therapy for moderate to severe migraines 2, 1
The American College of Physicians suggests NSAIDs as the first-line treatment for mild to moderate migraines due to their efficacy and tolerability profile 1
Effective NSAIDs for mild to moderate migraines include aspirin, ibuprofen, naproxen sodium, and combination medications containing acetaminophen, aspirin, and caffeine 1

Subcutaneous sumatriptan (6 mg) provides rapid pain relief within approximately 15 minutes, with efficacy rates of 70-82% 2
Non-oral routes, such as subcutaneous sumatriptan, intranasal sumatriptan or zolmitriptan, should be selected when nausea or vomiting are significant components of the migraine attack 3, 1

For mild to moderate migraines, the American College of Physicians recommends starting with NSAIDs 1
For moderate to severe migraines, the American Academy of Family Physicians recommends starting with triptans 1, 2
If significant nausea or vomiting is present, non-oral routes should be chosen 3, 1

The American Heart Association contraindicates triptans in patients with uncontrolled hypertension, basilar or hemiplegic migraine, or Wolff-Parkinson-White syndrome 4
Patients should try a medication for 2-3 headache episodes before abandoning that treatment option, as recommended by the American Academy of Family Physicians 2
Preventive therapy should be considered for patients with frequent migraines (≥2 attacks/month) or when acute treatments are contraindicated or ineffective, according to the American College of Physicians 4