Migraine Management in Adult Males

Acute Treatment Algorithm

The American Academy of Family Physicians recommends NSAIDs as first-line treatment for mild to moderate migraine attacks, with options including aspirin, ibuprofen, and naproxen sodium 3, 2
The American Academy of Neurology suggests adding a triptan when NSAIDs provide inadequate relief or for moderate to severe attacks, with options including sumatriptan, rizatriptan, zolmitriptan, and naratriptan 1, 5, 2, 6
For attacks with significant nausea or vomiting, non-oral routes of administration and antiemetics like metoclopramide are recommended 2, 6, 3, 4

The American Academy of Neurology recommends preventive therapy for patients with two or more migraine attacks per month with disability for 3+ days/month, or those using rescue medication more than twice weekly 2, 6
First-line preventive medications with documented efficacy include beta-blockers, topiramate, and amitriptyline, with topiramate being first-line for chronic migraine due to lower cost 7, 8

The American Headache Society recommends encouraging patients to use a headache diary to identify and avoid personal triggers, with common triggers including alcohol, caffeine, and stress 9, 10, 1
Regular exercise, weight management, and behavioral treatments like relaxation training, biofeedback, and cognitive behavioral therapy are also recommended 9, 10

The American Academy of Neurology advises limiting acute medications to no more than 2-3 days per week to prevent medication overuse headache, and being vigilant for rebound headaches from withdrawal of analgesics or triptans 1, 2, 6
Assessing for and managing common comorbidities like anxiety, depression, and sleep disorders is also important, as is setting realistic expectations for treatment outcomes 7, 8, 9, 10