Treatment Guidelines from The Medical Letter
Drugs for Migraine
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A nonopioid analgesic may be effective for treatment of mild-to-moderate migraine. A triptan is the drug of choice for treatment of moderate-to-severe migraine. The short-acting oral triptans sumatriptan, almotriptan, eletriptan, rizatriptan, and zolmitriptan are similar in their efficacy and speed of onset; naratriptan and frovatriptan have a slower onset and longer duration of action. The nasal spray formulations of sumatriptan and zolmitriptan have a faster onset of action than oral triptans. Subcutaneous sumatriptan is the fastest-acting and most effective triptan formulation. Patients who do not respond to one triptan may respond to another. For prevention of migraine, topiramate, valproate, propranolol, timolol, or metoprolol is recommended.


Treatment of migraine in the emergency department, which may involve use of intravenous drugs, is not discussed here.

ANALGESICS ... more      

The Medical Letter is a subscriber-funded nonprofit organization that publishes critical appraisals of new prescription drugs and comparative reviews of drugs for common diseases.

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