Article Figures & Data
Tables
Class Formulation Relative Contraindications Reduction in Migraine Attacks per Month vs Placebo Other Triptans PO ODT, spray, SQ, nasal spray Concomitant ergot or MAOI use Cerebrovascular syndrome Significant cardiovascular disease Hemiplegic or basilar migraine N/A Triptans are first-line treatment for severe migraines as they are generally highly effective, with a low risk of side effects
Failure of one triptan does not indicate failure of the entire class of medication. Consider trying a second triptan medication if the first one does not improve symptomsCGRP receptor antagonists PO, SQ, Intranasal N/A Seratonin 5-HT1F receptor antognists PO N/A Side effects: dizziness, fatigue Aspirin & NSAIDs (contraindicated if history of GI bleeding) PO N/A May be used with triptans, caffeine increases efficacy Antiemetics PO, IM, IV, suppositories People at risk for extrapyramidal syndromes (EPS) N/A Used as adjunctive treatment Ergots Sublingual tablets, suppositories Safety/efficacy not established in pediatrics Pregnancy Hemiplegic or basilar migraine Ischemic heart disease Severe hepatic or renal impairment N/A Rebound associated with overuse of this class
Oldest therapy for migraines
Side effects: nausea and anxiety are very commonAbbreviations: IV, intravenously; IM, intramuscularly; PO, Oral; ODT, orally dissolving tablet; SQ, subcutaneous.
Class Formulation Relative Contraindications Reduction in Migraine Attacks per Month vs Placebo Other Beta blockers PO Asthma Depression CHF Raynaud’s disease Diabetes Bradycardia 1.2637 Calcium channel blockers PO Constipation Hypotension Sick sinus syndrome Second- or third-degree AV block without pacemaker Severe left ventricular dysfunction May be combined with NSAIDs Ace inhibitors PO Pregnancy Hereditary or idiopathic angioedema 1.538 Antiepileptics PO Pregnancy
Kidney stones
Bleeding disorders
Weight loss concerns239 Sedative and confusion Tricyclic antidepressants PO 6.946 Anti-CGRP antibody IV Avoid in pregnancy and in adults with cardiovascular risks or vascular malformations N/A Abbreviations: IV, intravenously; PO, Oral.
