The treatment for migraines can be broadly categorized into acute management and prophylactic measures.
Acute management
- Analgesics: For acute migraine attacks, the SIGN 2023 guidelines recommend offering ibuprofen 400 mg as first-line therapy, with the dose increased to 600 mg if ineffective . Acetaminophen 1,000 mg is also recommended for patients unable to take other acute therapies
- Triptans: Triptans, such as sumatriptan 50–100 mg, are recommended as first-line therapy for acute migraine attacks . If sumatriptan fails, other triptans may be considered
- Antiemetics: For nausea and vomiting caused by acute migraine, metoclopramide in combination with aspirin is recommended
Prophylactic measures
- First-line agents: Propranolol 80–160 mg daily and topiramate 50–100 mg daily are recommended as first-line prophylactic treatments for patients with episodic or chronic migraine
- Second-line agents: Amitriptyline 50–150 mg, venlafaxine 75–150 mg, naproxen 2×250–500 mg, petasites 2×75 mg, and bisoprolol 5–10 mg are recommended as second-line agents for migraine prophylaxis
- Third-line agents: Acetylsalicylic acid 300 mg, gabapentin 1,200–1,600 mg, magnesium 24 mmol, Tanacetum parthenium 3×6.25 mg, riboflavin 400 mg, coenzyme Q10 300 mg, candesartan 16 mg, lisinopril 20 mg, and methysergide 4–12 mg are recommended as third-line agents for migraine prophylaxis
Non-pharmacological interventions
- Manual therapies: Manual therapies such as massage therapy, physiotherapy, relaxation, and chiropractic spinal manipulative therapy might be equally effective as propranolol and topiramate in the prophylactic management of migraine
- Vitamins and dietary supplements: Riboflavin (400 mg) is recommended as a third-line choice for migraine prophylaxis
In conclusion, the treatment of migraines involves a combination of acute management and prophylactic measures, with both pharmacological and non-pharmacological options available. The choice of treatment should be individualized based on the patient's specific clinical characteristics, preferences, and needs.