Migraine : Acute management

Acute migraine management involves the prompt treatment of migraine attacks with the goal of reducing pain, restoring normal function, and minimizing recurrence. Treatments are generally categorized into migraine-specific and non-specific therapies.

Migraine-specific medications include triptans (such as sumatriptan and rizatriptan), ergot derivatives, and more recently, calcitonin gene-related peptide (CGRP) antagonists. These therapies have been shown to be effective in relieving migraine symptoms by targeting the mechanisms that drive migraine pathophysiology (Buse et al., 2015; Marzoughi & Spacey, 2023; Marmura et al., 2015).

However, it is important to note that ergot derivatives and opioids are not recommended by NICE Clinical Knowledge Summaries (CKS) for routine use in the management of acute migraine. This is due to concerns about their efficacy, side effects, and the risk of medication overuse headaches. NICE recommends focusing on more effective and safer alternatives, such as triptans, NSAIDs, and CGRP antagonists, to manage acute migraine episodes.

Calcitonin gene-related peptide (CGRP) antagonists are a newer class of medications specifically designed for the treatment and prevention of migraines. CGRP is a neuropeptide that plays a crucial role in migraine pathophysiology by promoting inflammation and dilating blood vessels in the brain, which contributes to the pain and other symptoms...