Table 5.
Drugs for the symptomatic treatment of migraine with a level of recommendation I and II
| Drug | Dosage (mg) | Level of recommendation | Comments |
|---|---|---|---|
| 5HT1B/1D agonists | |||
| Sumatriptan | |||
| Subcutaneous | 6 | Rapid onset of action compared to the other formulations | |
| Tablet | 50–100 | I | |
| Suppository | 25 | Useful when oral route is not possible due to nausea | |
| Nasal spray | 20 | Useful when oral route is not possible due to nausea | |
| Zolmitriptan | Rapid onset of action | ||
| Tablet | 2.5 | ||
| Oral disintegrating tablet | 2.5 | I | |
| Nasal spray | 2.5–5 | ||
| Rizatriptan | Rapid onset of action. The optimal dosage is 10 mg | ||
| Tablet | 5–10 | I | |
| Oral disintegrating tablet | 10 | Recommended dosage is 5 mg in patients treated with propranolol which increases the plasma concentration of rizatriptan | |
| Eletriptan | |||
| Tablet | 20, 40 | I |
The optimal dosage is 40 mg (best efficacy/tolerability ratio) The dosage of 20 mg is recommended in the case of renal or liver failure |
| Almotriptan | |||
| Tablet | 12.5 | I | Good tolerability profile |
| Frovatriptan | |||
| Tablet | 2.5 | I | Long half-life, good tolerability profile |
| Ergot derivatives | |||
| Ergotamine oral, rectal, subcutaneous | 1–2 | II | Indicated in the case of infrequent migraine attacks. Risk of abuse and headache chronification. An excessive use may cause ergotism |
| NSAIDs | |||
| Acetylsalicylic acid (ASA) oral | 500–1,000 | I |
Good efficacy/tolerability profile Gastrointestinal adverse events |
| Lisine acetylsalicylate oral | 500–1,000 | I |
Good efficacy/tolerability profile Gastrointestinal adverse events |
| Lisine acetylsalycilate i.v. | 1,000 | I | To be used in a hospital setting. Risk of bleeding |
| Diclofenac–K+ oral | 100 | II | In the case of frequent migraine attacks risk of abuse and headache chronification |
| Diclofenac–Na+ i.m. | 75 | II | |
| Flurbiprofen oral | 100–300 | II | |
| Ibuprofen oral | 400–1,200 | I | |
| Ibuprofen oral | 200 | II | |
| Ketoprofen i.m. | 100 | II | |
| Ketorolac i.m. or i.v. | 30–60 | II | Clinical trials have been performed in particular settings (emergency departments) |
| Metamizole (dipirone) i.v. or oral | 1,000 | II | Potential risk of agranulocytosis >0.1 % and hypotension (i.v. formulation) |
| Naproxen oral | 500–1,500 | I | |
| Na + Naproxen oral | 550–1,500 | I | |
| Mefenamic acid per os | 500 | II | Effective in menstrual migraine attacks |
| Combination analgesics | |||
| Paracetamol + acetyl salicylic + caffeine suppository | 500 + 500 + 130 | To be used for attacks of moderate intensity. Effective also in the treatment of menstrual migraine. In the case of frequent migraine attacks, risk of abuse and headache chronification | |
| Indomethacin + prochlorperazine + caffeine oral | 25 + 2 + 75 | I | In the case of frequent migraine attacks, risk of abuse and headache chronification |
| Indomethacin + prochlorperazine + caffeine suppository | 25–50 + 4–8 + 75–150 | II | See above |
| Paracetamol + codeine per os | 400–650 + 6–25 | II | See above |
| Antiemetics | |||
| Metoclopramide i.v. | 0.1 /kg 1−3 times | II | To be used in a hospital setting |