Table 1.

Treatment for Acute Migraines

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 symptoms
CGRP 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 common

Abbreviations: IV, intravenously; IM, intramuscularly; PO, Oral; ODT, orally dissolving tablet; SQ, subcutaneous.