Migraine Treatment Guidelines

Acute Treatment for Episodic Migraine

For moderate to severe episodic migraine, combination therapy of a triptan with an NSAID or acetaminophen is recommended as first-line treatment, according to the American College of Physicians, with a strength of evidence of high 1, 2
Treatment should begin as soon as possible after headache onset to maximize efficacy, with a strength of evidence of moderate 2
For patients who don't respond to or cannot tolerate first-line treatments, consider CGRP antagonists-gepants, with a strength of evidence of high 1, 4

Patients with chronic migraine still require acute treatment for breakthrough headaches, following the same principles as for episodic migraine, with a strength of evidence of moderate 1, 2

First-line preventive options include beta-blockers, antiseizure medication valproate, SNRIs, or TCAs, with a strength of evidence of high 6
CGRP antagonists-gepants or CGRP monoclonal antibodies are effective preventive options, with a strength of evidence of high 6

Stay well hydrated and maintain regular meals, with a strength of evidence of low 1, 5
Ensure sufficient and consistent sleep patterns, with a strength of evidence of moderate 2
Engage in regular physical activity, preferably moderate to intense aerobic exercise, with a strength of evidence of moderate 1
Manage stress with relaxation techniques or mindfulness practices, with a strength of evidence of low 2, 4
Pursue weight loss if overweight or obese, with a strength of evidence of moderate 2
Identify and avoid personal migraine triggers, with a strength of evidence of low 1, 5