Migraine Acute Treatment

1st line/OTC treatments

• Aspirin 600-900mg up to 4 doses in 24 hours
• Ibuprofen 400-600mg up to 4 doses in 24 hours
• Paracetamol 1g up to 4 doses in 24 hours (500mg if weight less than 50kg) if mild / moderate or unable to tolerate NSAIDs.

---

Anti-emetics

Anti-emetics may aid absorption of acute treatments, please consider even in absence of nausea.

• Domperidone or Prochlorperazine

---

Second line/triptans

If patient fails to respond please consider trial of a different triptan/or a different route.
Formulary choices:

• Almotriptan5mg
• Zolmatriptan5mg or 5mg
• Rizatriptan 10mg
• Sumatriptan oral 50mg or 100mg (use 100mg if 50mg ineffective) or Sumatriptan injection

---

Triptan non-responders/ contraindications

Non-response = inadequate relief to trials of at least 2 triptans with appropriate timing (take triptan early in headache), correct route of administration and combination treatment has been considered.

• Rimegepant 75mg taken as a once off dose

---

 

Further information

National Headache Pathway - Acute Treatment of Migraine in Primary Care