Table 2:
Drug category | Drug(s) | Canadian Headache Society | |
---|---|---|---|
Level of evidence* | Strength of recommendation† | ||
Recommended for use in episodic migraine | |||
Triptans | Almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan | High | Strong |
Acetaminophen and NSAIDs | Acetaminophen, acetylsalicyclic acid, diclofenac potassium, ibuprofen, naproxen sodium | High | Strong |
Combination analgesics | Naproxen–sumatriptan | High | Strong |
Anti-emetics (adjunct) | Metoclopramide | Moderate | Strong |
Domperidone | Low | Strong | |
Ergots | Dihydroergotamine (nasal, subcutaneous) | Moderate | Weak |
Not recommended for routine use in episodic migraine‡ | |||
Ergots | Ergotamine | Moderate | Weak |
Opioids and tramadol | Opioids or opioid-containing combination analgesics | Low | Weak |
Tramadol or tramadol-containing combination analgesics | Moderate | Weak | |
Not recommended for use in episodic migraine§ | |||
Synthetic opioids | Butorphanol nasal spray | Low | Strong against |
Barbiturates | Butalbital-containing combination analgesics | Low | Strong against |
Note: GRADE = Grading of Recommendations Assessment, Development and Evaluation, NSAID = nonsteroidal anti-inflammatory drug.
Levels of evidence using the GRADE system: high = the guideline authors are confident that the true effect lies close to the estimate given by the evidence available; moderate = the guideline authors are moderately confident in the effect estimate, but there is a possibility it is substantially different; low = the confidence in the effect estimate is limited and the true effect may be substantially different; very low = the guideline authors have little confidence in the effect estimate.
Recommendation categories using the GRADE system: strong = benefits clearly outweigh risks and burdens for most patients; weak = the balance between benefits and risks is narrow and there is uncertainty about when it should be used.
Not recommended for routine use but may be considered for occasional use when other medications have failed.
Should be avoided except in exceptional circumstances.
Adapted with permission from Worthington I, Pringsheim T, Gawel MJ, et al.; Canadian Headache Society guideline: acute drug therapy for migraine headache. Can J Neurol Sci 2013;40(Suppl 3):S1–80.