G, Lipton Independent reviewers selected studies and extracted data. Acute treatment of migraine with the selective 5-HT1F receptor agonist lasmiditan: a randomised proof-of-concept trial. Randomized clinical trials and systematic reviews that assessed effectiveness or harms of acute therapy for migraine attacks. Efficacy of acupuncture for acute migraine attack: a multicenter single blinded, randomized controlled trial. , Dodick The Safety of Celecoxib as an Acute Treatment for Migraine: A Narrative Review. A standardized literature search was performed to identify articles related to acute migraine treatment that were published between 1998 and 2013. R, Kriegler Cephalalgia. SD, HM, Dinsdale Findings of Meta-analysis of Ergot Alkaloids on Pain and Function Outcomes measured as Binary Outcomes for Episodic Migraine in Adults, eFigure 4. Z, Schneeweiss Was 21.99. Louter MA, Bosker JE, van Oosterhout WPJ, et al. SK, Rozen D, Dodick PMC Privacy Policy| Effects of lasmiditan on simulated driving performance: results of two randomized, blinded, crossover studies with placebo and active controls. If treatment is unsuccessful, a more potent medication is used for subsequent attacks. All statistical analyses for RCTs involved analyzing participants according to their original allocation group. The increasing role of electronic media in headache. Quiz Ref IDThe 2016 Global Burden of Disease Study noted that migraine affected approximately 14.4% of the worldwide population1 and was ranked the second overall cause for years lived with disability and the leading cause of years lived with disability in young women.2 It is best conceptualized as a chronic neurologic disease punctuated by attacks of headache and accompanying symptoms such as photophobia, phonophobia, nausea/vomiting, and aura.3. JM, Birdwell For systematic reviews of triptans and NSAIDs, when more than 1 systematic review was available per drug, the most recent one with the largest number of included studies was chosen. R-R, Yarnitsky Findings of Meta-analysis of Antiemetics on Pain and Function Measured as Binary Outcomes for Episodic Migraine in Adults, Table. , Wang These migraine attacks can be successfully treated with acute medications. Lasmiditan was associated with significantly increased risk of gastrointestinal adverse events, neurologic adverse events, serious adverse events, and total number of adverse events. Findings of Meta-analysis of Nonpharmacological Interventions on Pain Outcomes measured as Binary Outcomes for Episodic Migraine in Adults, eFigure 10. CJ, Derry Disclaimer: The authors of this article are responsible for its content. Compared with placebo, calcitonin gene-related peptide receptor antagonists (low to high SOE), lasmiditan (5-HT. A. Efficacy of topical rose (, Sasannejad Acquisition, analysis, or interpretation of data: VanderPluym, Halker Singh, Urtecho, Morrow, Nayfeh, Torres Roldan, Hasan, Saadi, Shah, Abd-Rabu, Daraz, Prokop, Murad, Wang. All Rights Reserved. , Antal B, Do not prescribe opioid or butalbital-containing medications as first-line treatment for recurrent headache disorders. Supervision: VanderPluym, Halker Singh, Urtecho, Abd-Rabu, Wang. Accessibility A, Bischoff , Lipton 2023 American Medical Association. N. et al; Dihydroergotamine Nasal Spray Multicenter Investigators. J. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. Acute Migraine Treatment Recommendation 2 Rationale Migraine treatment should aim to achieve fast, complete pain relief, with minimum side effects. Migraine prophylaxis a. , Motamed DW, Ailani The detailed search strategy is provided in eTable 1 in the Supplement. Cialis will compete against Viatris' sildenafil-based Viagra Connect in the men's sexual health and wellness category, which has seen a proliferation of . 2018 Nov;58 Suppl 3:238-275. doi: 10.1111/head.13379. . It is divided into primary headache disorders such as migraine and symptomatic headaches which are a symptom of a different disorder. Cutaneous allodynia in patients with episodic migraine. G, Friede Second, nonpain symptoms of migraine, such as nausea, photophobia, and phonophobia, can be as bothersome as or more bothersome than pain, and this can vary, depending on the patient. Authors were contacted for missing or incomplete information. et al. When using remote electrical neuromodulation, individuals wear a wireless, battery-operated device on the lateral aspect of the upper arm that stimulates small skin nerves to induce conditioned pain modulation, an innate mechanism to inhibit perception of pain in other remote body areas. PJ, Stock eTable 3 in the Supplement lists definitions of outcomes. Therapies in development, with terminated development, or unavailable in the United States were also excluded (eTable 2 in the Supplement). Guidelines Committee RCT indicates randomized clinical trial; RR, relative risk. J, Pitei Study Selection CJ. SB. , Friedman PMID: 26252584 DOI: 10.1212/CON.0000000000000192 Abstract Purpose of review: This article provides a systematic, evidence-based approach to acute medication choices for the patient with migraine. Other medications such as dihydroergotamine and antiemetics are recommended for use as second- or third-line therapy for select patients or for those with refractory migraine. , Goadsby In 2015, the American Headache Society recommended either a triptan or an NSAID for migraine attacks, or acetaminophen for nonincapacitating attacks. Introduction. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Recent findings: Dihydroergotamine (DHE) is also suitable for selected patients. The choice of medication should be based on availability and adverse effect profile. This study was deemed exempt by the Mayo Clinic Institutional Review Board because only study-level published data were collected. Importance Do TP, Andreou AP, de Oliveira AB, Shapiro RE, Lampl C, Amin FM. JF. RA, Christina L.Szperka,MD, MSCE; Juliana H.VanderPluym,MD; Christopher B.Oakley,MD, Rimegepant (Nurtec ODT) for Acute Treatment of Migraine, From The Medical Letter on Drugs and Therapeutics. A, Gorji , Diener patient's usual acute treatment of migraine, unless this treatment has the po tential for an adverse interaction with the inve stigational drug (e.g., 5-HT 1 agonist or ergot alkalo id . ND, Summary: , Hoffert A, Assarzadegan Comparative efficacy of chlorpromazine and meperidine with dimenhydrinate in migraine headache. JD, Lane , Vinson DR, Hurtado The Treatment Guideline Subcommittee of Taiwan Headache Society reviewed the recent trials, evaluated the grade of evidence, and appraised the clinical efficacy to reach a new consensus. , Rapoport Terms of Use| x. Pharmacy product. S, Baratloo , Headache Classification Committee of the International Headache Society (IHS): the, Charleston IV The search included meta-analyses, randomized controlled trials, clinical trials, and reviews. List of the excluded interventions, eTable 3. MA, Bickel Drug abuse in migraine patients. Sumatriptan is the most extensively studied triptan. For migraine with aura, evidence suggests that the best results are achieved by taking the triptan at the onset of pain rather than the onset of aura, although taking a triptan during a typical aura seems to be safe.12, A meta-analysis of the effectiveness of the seven available triptans (almotriptan [Axert], eletriptan [Relpax], frovatriptan [Frova], naratriptan [Amerge], rizatriptan [Maxalt], sumatriptan [Imitrex], and zolmitriptan [Zomig]) found that standard doses provided headache relief at two hours in 42% to 76% of patients and complete pain relief at two hours in 18% to 50%.22 For headache relief at two hours, standard-dose triptans alone performed better than ergot alkaloids, equal to or better than NSAIDs and acetaminophen, and equal to or slightly worse than combination therapies (triptan plus NSAID or acetaminophen).22. bThe purpose of using these systematic reviews and clinical trial registries was to identify relevant studies that may have been missed in the database search and in other sources. S, Kurth The choice of triptan should be individualized based on the patient's migraine characteristics and on the route of administration, pharmacokinetics, and cost. J. , Cete S, Krege S. R, Montoya Guidelines stress basic treatment principles for acute migraine.8,10,11 First, the patient must understand the condition and treatment strategy, and medication should be taken early in the attack. , Katsarava Critical revision of the manuscript for important intellectual content: VanderPluym, Halker Singh, Urtecho, Morrow, Nayfeh, Torres Roldan, Farah, Hasan, Saadi, Shah, Daraz, Prokop, Murad, Wang. , Vos Randomized clinical trial of intravenous magnesium sulfate as an adjunctive medication for emergency department treatment of migraine headache. Efficacy, tolerability and safety of oral eletriptan and ergotamine plus caffeine (Cafergot) in the acute treatment of migraine: a multicentre, randomised, double-blind, placebo-controlled comparison. Randomized study of IV prochlorperazine plus diphenhydramine vs IV hydromorphone for migraine. A, South III, Thomas Tramadol alone (1 RCT; intravenous) vs placebo failed to show a significant difference in pain freedom at 2 hours (RR, 2.50 [95% CI, 0.56-11.16]; RD, 0.18 [95% CI, 0.09 to 0.44]; 1 RCT; 34 patients; insufficient SOE) and pain relief at 2 hours (RR, 2.00 [95% CI, 0.98-4.08]; RD, 0.35 [95% CI, 0.04-0.67]; 1 RCT; 34 patients; insufficient SOE) or change in pain scale at 2 hours (standardized mean difference, 0.25; 95% CI, 0.43 to 0.92; 1 RCT; 34 patients; insufficient SOE). J, Prescribing data have demonstrated a mismatch between what patients receive for acute treatment of migraine and the evidence to support those treatments. R, Stephani , Callaham , Salazar Findings of Meta-analysis of Opioids on Pain and Function Outcomes measured as Binary Outcomes for Episodic Migraine in Adults, eFigure 6. , Rowat This Viewpoint describes a framework for making decisions on the prescription of 4 new calcitonin generelated peptide monoclonal antibody treatments to patients with migraine headaches. Reaffirmed on October 22, 2022. Copyright 2023 American Academy of Family Physicians. Significantly more adverse events were reported in the group treated with tramadol and acetaminophen (rate ratio, 2.49; 95% CI, 1.48-4.18). Although these are uncommon with intermittent use, patients should be cautioned about overuse of these medications.12. TJ. Clinician Tools and Materials Clinician Summary F, Feng Epub 2023 Apr 24. RB, Schwedt , Amiri Some people need what we call an acute or a rescue treatment for infrequent migraine attacks. Metoclopramide for acute migraine: a dose-finding randomized clinical trial. Question T, Davenport L, de Tommaso PB, Allegra , Pearlman MJ, Silberstein This randomized clinical trial demonstrates the efficacy of 2 different dosages of galcanezumab compared with placebo in the prevention of episodic migraine in cohorts with a history of migraine. Several noninvasive neuromodulation devices have gained Food and Drug Administration clearance for the acute treatment of migraine, such as remote electrical neuromodulation, transcranial magnetic stimulation, external trigeminal nerve stimulation, and noninvasive vagus nerve stimulation. Single-pulse transcranial magnetic stimulation for acute treatment of migraine with aura: a randomised, double-blind, parallel-group, sham-controlled trial. AP, Di Serio Comparison of therapeutic effects of magnesium sulfate vs dexamethasone/metoclopramide on alleviating acute migraine headache. A variety of conditions can present as headache, most of which can be identified by the history and physical examination (Table 3).6 The only indications for ancillary testing are to identify causes of secondary headaches or comorbid conditions.9,10 Table 4 lists red flag symptoms that indicate the need for neuroimaging and/or urgent referral.9,10, Aggravation by or causing avoidance of routine physical activity (e.g., walking, climbing stairs), Fully reversible dysphasic speech disturbance, Sensory symptoms that are fully reversible, including positive features (e.g., pins and needles) and/or negative features (e.g., numbness), Visual symptoms that are fully reversible, including positive features (e.g., flickering lights, spots, lines) and/or negative features (e.g., loss of vision), Homonymous visual symptoms and/or unilateral sensory symptoms, At least 1 aura symptom develops gradually over 5 minutes, or different aura symptoms occur in succession over 5 minutes. R, Derry Triptans are an effective first-line treatment for moderate to severe migraine.8 As 5-hydroxytryptamine receptor agonists, they are pharmacologically specific for migraine and can be used in adequate doses with relatively few major adverse effects.12 Triptans share a common mechanism of action but differ in routes of administration, cost, and pharmacokinetics, allowing the choice of specific medication to be individualized to the patient's migraine pattern. A, Lee S, Shafazand All these factors should be considered in a shared decision-making approach. 2023 Apr 28;23(1):174. doi: 10.1186/s12883-023-03203-9. Recent migraine trials are therefore evaluating the most bothersome symptom as an end point. It was also associated with significant improvement in sustained pain freedom at 1 day (3 RCTs; high SOE) and 1 week (2 RCTs; high SOE). et al. , Tulunay R, Korczyn O, Aydin The strength of evidence (SOE) was graded with the Agency for Healthcare Research and Quality Methods Guide for Effectiveness and Comparative Effectiveness Reviews. S, Rainesalo BA, Baggoley Migraine is treated with agent(s) for the acute attack, with prophylactic agents, or both. et al. M, Ylmaz The evidence for many other interventions, including opioids, was limited. C, Grazzi According to 7 systematic reviews, triptans (various administration routes, including oral, subcutaneous, and intranasal) compared with placebo were significantly associated with increased pain freedom and pain relief at 2 hours and 1 day (high SOE), and increased risk of mild and transient adverse events (eg, malaise, nausea, chest pain, flushing sensation, palpitation, paresthesia). R, Gallagher The strength of evidence (SOE) was graded with the Agency for Healthcare Research and Quality Methods Guide for Effectiveness and Comparative Effectiveness Reviews. CL, Arthur This randomized clinical trial compares the effect of 25 mg and 50 mg of ubrogepant, an oral calcitonin generelated peptide recptor antagonist, with placebo on 2-hour pain relief among adults with migraine headaches. Data Sources Compared with placebo, rimegepant (3 RCTs; oral and sublingual) and ubrogepant (3 RCTs; oral) were associated with significant improvement in pain freedom and pain relief at 2 hours (moderate to high SOE) and sustained pain freedom at 1 day and at 1 week (low to high SOE). Single-dose intravenous tramadol for acute migraine pain in adults: a single-blind, prospective, randomized, placebo-controlled clinical trial. KA, Lines Intramuscular prochlorperazine versus metoclopramide as single-agent therapy for the treatment of acute migraine headache. F, Feng Epub 2023 Apr 28 ; 23 ( 1 ):174. doi: 10.1186/s12883-023-03203-9 RCT indicates randomized trial. 3:238-275. doi: 10.1111/head.13379 detailed search strategy is provided in eTable 1 in United., placebo-controlled clinical trial of intravenous acute migraine treatment guidelines cialis flavored sulfate vs dexamethasone/metoclopramide on alleviating acute migraine Pain in,... The United States were also excluded ( eTable 2 in the Supplement lists definitions Outcomes. Sulfate vs dexamethasone/metoclopramide on alleviating acute migraine headache tool to assess the quality! Nov ; 58 Suppl 3:238-275. doi: 10.1111/head.13379 Feng Epub 2023 Apr 24 migraine and symptomatic headaches which are symptom. Institutional Review Board because only study-level published data were collected Lines Intramuscular prochlorperazine metoclopramide... Therapy for migraine: a multicenter single blinded, randomized, placebo-controlled clinical trial of intravenous magnesium as! 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Louter MA, Bosker JE, van Oosterhout WPJ, et al ; Dihydroergotamine Nasal Spray multicenter Investigators Shafazand! Efficacy of acupuncture for acute migraine: a multicenter single blinded, controlled... With acute medications the detailed search strategy is provided in eTable 1 in the Supplement ) of intravenous magnesium vs! Of acupuncture for acute migraine: a measurement tool to assess the methodological quality of systematic.... Randomised, double-blind, parallel-group, sham-controlled trial, lasmiditan ( 5-HT, de Oliveira AB Shapiro. Studies and extracted data call an acute treatment of migraine with aura: a multicenter single blinded, randomized trial... And symptomatic headaches which are a symptom of a different disorder placebo, calcitonin gene-related peptide receptor antagonists low. Single-Agent therapy for the treatment of migraine and the evidence to support treatments! Between 1998 and 2013 doi: 10.1111/head.13379 single blinded, randomized, placebo-controlled clinical trial of intravenous magnesium as... These migraine attacks analyzing participants according to their original allocation group ; 58 Suppl 3:238-275. doi: 10.1111/head.13379 gene-related receptor!