Acute Treatment of Migraine

Bert B. Vargas, MD, FAAN, FAHS Headache p. 1032-1051 August 2018, Vol.24, No.4 doi: 10.1212/CON.0000000000000639
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PURPOSE OF REVIEW: This article provides a framework to help providers formulate a plan for the acute treatment of migraine. Topics covered include the cost-effective patient-centered approach known as stratified care and a summary of evidence-based treatment options that are currently available. Strategies for improving treatment response, troubleshooting suboptimal results, and addressing the needs of special populations are also reviewed.

RECENT FINDINGS: Both the American Headache Society and the Canadian Headache Society have released evidence-based assessments and reviews of acute treatments for migraine that can be used to help guide treatment decisions. Although several older medications have been re-released with new formulations or new delivery systems, several new medications have also become available or are in the final phases of study, further increasing the number of options available for patients.

SUMMARY: The acute management of migraine should incorporate a stratified care model in concert with evidence-based treatment options. The response to treatment should be monitored regularly, and measures should be taken to identify suboptimal tolerability or efficacy.

Address correspondence to Dr Bert B. Vargas, University of Texas Southwestern Medical Center, 3030 Waterview Pkwy, Richardson, TX 75080, Bert.Vargas@UTSouthwestern.edu.

RELATIONSHIP DISCLOSURE: Dr Vargas has received personal compensation for serving on the advisory boards of Alder BioPharmaceuticals, Inc; Allergan; Amgen Inc; Avanir Pharmaceuticals, Inc; Eli Lilly and Company; Pernix Therapeutics; Teva Pharmaceutical Industries Ltd; and Upsher-Smith Laboratories, LLC; for serving on the speaker’s bureau of Amgen Inc and Avanir Pharmaceuticals, Inc; and has received travel compensation for serving as an editor for Neurology Today.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Vargas discusses the unlabeled/investigational use acetaminophen, acetylsalicylic acid, dexketoprofen, diclofenac, dipyrone, droperidol, haloperidol, ibuprofen, ketorolac, lasmiditan, metoclopramide, naproxen, peripheral nerve block, prochlorperazine, and valproate for the acute treatment of migraine.

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© 2018 American Academy of Neurology