Table 2.

Dosing of Medications for Acute Migraine, and Estimation of their Efficacy Based on the Most Methodologically Robust Trial Involving that Agent Performed in an Emergency Room Setting

Class	Medication	Typical Dose and Route	Estimation of Efficacya
Dopamine receptor antagonist
	Chlorpromazine	0.1 mg/kg to 25 mg IV or IM	83%18 effective at 1 hour in a small, randomized, double-blind placebo-controlled trial. IV/IM route effective in 67%35-88%41 at 3037 to 6035,41 minutes in small, randomized, double-blind, placebo-controlled trials. PR route had a positive outcome in all patients at 2 hours in a small, randomized, double-blind, placebo-controlled trial40
	Prochlorperazine	10 mg IV or IM; 25 mg PR
	Promethazine	25 mg IM (caution with IV administration)	NA
	Metoclopramide	10 mg IV	Effective in 34%35-46%37 at 3037 to 6035 minutes in small, prospective, randomized, double-blind, placebo-controlled trials.
Serotonin (5-HT1B/1D) receptor agonists: triptansb
	Sumatriptan	6 mg SC	Effective in 75%51 at discharge in a randomized, placebo-controlled, double-blind trial Mean pain score of the study group decreased significantly at 60 minutes in a small, prospective, randomized double-blind trial52
		10 or 20 mg intranasal
Ergot derivatives
	Dihydroergotamine	0.5 to 1 mg IM or IV	60% reduction in mean pain rating at 1 hour in a small double-blind, placebo-controlled study using 0.75 mg IV DHE5,8
NSAIDsb
	Ketorolac	30 mg IM or IV	Approximately 80% decrease in mean pain rating at 2 hours using 60 mg ketorolac IM in a small randomized, double-blind trial7 Significant decrease in median pain score for the group (by approximately 57%) at 1 hour using 30 mg IV ketorolac in a small, randomized, double-blind trial.39
	Diclofenac	75 mg IM	80% effective at 2 hours in a small, randomized, double-blind study70
Antiepileptics	Sodium valproate	300-1200 mg IV	Effective in 75% at 50 minutes in a small open-label study,13 with results of a small, randomized double-blind trial less encouraging with only 21% of patients given valproate not requiring additional rescue medication43

Abbreviations: IM, intramuscular; IV, intravenous; NSAIDs, nonsteroidal anti-inflammatory drugs; PR, per rectum.

^a See the corresponding section in the text for a more complete description of each agent’s efficacy in trials. Due to the heterogeneity in the trials’ primary end points, direct comparison of efficacy between agents within this table is not possible. Only trials performed in an emergency room setting were included in this table.

^b Triptans and NSAIDs can be combined for improved efficacy⁵³ in treating acute migraine, though this has not been specifically studied in the emergency department setting.