Recommended Abortive Medications for Migraines

First-Line Treatment Options

The American College of Physicians recommends NSAIDs with proven efficacy, including aspirin, ibuprofen, naproxen sodium, and the combination of acetaminophen plus aspirin plus caffeine, as first-line therapy for migraine sufferers 1
Acetaminophen alone lacks evidence for efficacy in migraine treatment, according to the American College of Physicians 1
The American Academy of Neurology recommends triptans, including oral sumatriptan, naratriptan, rizatriptan, and zolmitriptan, as first-line therapy for moderate to severe migraine attacks 1
Subcutaneous sumatriptan and dihydroergotamine (DHE) nasal spray are also recommended as first-line therapy for moderate to severe migraine attacks, with good evidence for efficacy 1, 2

The American College of Physicians recommends starting with NSAIDs, such as aspirin, ibuprofen, and naproxen sodium, for mild to moderate migraine attacks 1
If inadequate response within 2 hours, the American Academy of Neurology recommends escalating to a triptan, such as sumatriptan or rizatriptan 1

The American College of Physicians recommends selecting a non-oral route of administration, such as subcutaneous or nasal spray, for migraine attacks with significant nausea or vomiting 1, 3
The American Academy of Neurology recommends adding an antiemetic, such as metoclopramide or prochlorperazine, to treat nausea, even if vomiting is not present 1

The American College of Physicians recommends antiemetics, such as metoclopramide and prochlorperazine, for migraine with significant nausea 1, 3

The American Academy of Neurology recommends systemic corticosteroids as the treatment of choice for status migrainosus 2, 3
Intravenous corticosteroids are the mainstay of treatment, according to the American Academy of Neurology 3
The American College of Physicians recommends giving antiemetics concurrently to treat nausea and improve gastric motility 3
Parenteral NSAIDs, such as ketorolac, can be effective due to rapid onset, according to the American College of Physicians 3