Table 5 Drugs for the symptomatic treatment of migraine with a level of recommendation I and II

5HT_1B/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