Table 3 Medicines with marketing approval (MA) for the acute treatment of migraine attacks

Symptomatic treatment for migraine attacks and for associated digestive problems

Lysine acetylsalicylate + metoclopramide

900 mg at the start of the attack

Linked to metoclopramide

Linked to metoclopramide Pheochromocytoma, gastrointestinal haemorrhage, stenosis or perforation of the gut, previous history of late drug dyskinesia, contra-indicated in children

Neuropsychiatric problems, late dyskinesia, extrapyramidal syndrome, endocrine problems

Linked to salicylate

Linked to salicylate

Digestive problems, haemorrhagic syndrome, sensitivity reaction, Reyes syndrome

Gastro-duodenal ulcer, hypersensitivity to salicylates, haemorrhagic risk

Specific treatments : ergot derivatives

Ergotamine tartrate

Adult/child >10 years

Ergotism, nausea, vomiting

Hypersensitivity to ergot derivatives, obstructive coronary artery disease, heart failure, shock, arterial hypertension, severe infection, severe liver failure

Adult: 2 mg/day (up to 6 mg/day maximum and 10 mg/week maximum).

Child >10 years: 1/2 dose

Dihydroergotamine

Adult >16 years and <65 years

Ergotism, precordialgia with the injectable form, transient local reactions such as nasal obstruction and rhinorrhoea with the endonasal form

Endonasal solution

One spray in each nostril at the start of the attack

Injectable solution

1 renewable ampoule, 30 to 60 min later

2 mg maximum per day and 8 mg maximum per week

Specific treatments: selective 5HT1 receptor agonists (adults from 18 to 65 years)

Almotriptan

Tablet of 12.5 mg/maximum 25 mg/day

Vasomotor hot flushes, dizziness, feeling of weakness, asthenia, somnolence, nausea, vomiting, rare cases of heart flutter.

Hypersensitivity, previous history of: myocardial infarction, ischemic heart disease, coronary vasospasm (Prinzmetal angina), peripheral vascular disease, cerebrovascular accident or transitory ischemic accident

Eletriptan

Tablet of 40 mg/maximum 80 mg/day

Frovatriptan

Tablet of 2.5 mg/maximum 5 mg/day

Naratriptan

Tablet of 2.5 mg/maximum 5 mg/day

Rizatriptan

Tablets of 5 and 10 mg, dry powder of 10 mg/maximum 20 mg/day

Patients with severe liver failure

Sumatriptan

Tablet of 50 mg/maximum 300 mg/day SC injection ampoule 6 mg/maximum 12 mg/day. Nasal spray of 10 and 20 mg/maximum 40 mg/day

Moderate or severe hypertension, of pins and needles, sensation of heat, of pressure or of suffocation

Moderate or severe hypertension and in patients with uncontrolled mild hypertension

Zolmitriptan

Tablet of 2.5 mg, orodispersible at 2. mg/maximum 10 mg/day

Association with monoamine oxidase inhibitors (MAOI)