CMAJ - May 1, 1997 / Table 2: Guidelines for the diagnosis and management of migraine in clinical practice

Guidelines for the diagnosis and management of migraine in clinical practice

Table 2: Medications recommended for moderate migraine attacks*

Medication† Dosage‡ Main side effects Level of evidence

NSAID§[22-36]
Ibuprofen
Naproxen sodium
Mefenamic acid
400-800 mg PO q2-6h
275-550 mg PO q2-6h
250-500 mg PO q6h
GI upset
GI upset
GI upset
I
I
I

5-HT₁ receptor agonist
Selective
Sumatriptan[37-47]

50-100 mg PO (may be repeated twice within 24 h)
6 mg SC (may be repeated once within 24 h)

Chest tightness, tingling

I

Non-selective
DHE||[47-52]
0.5-1.0 mg SC, IM or IV (may be repeated at 1 h; maximum 4 doses within 24 h)
Chest tightness, tingling, nausea
I

Ergotamine¶[28-32,53] 1-2 mg PO q1h × 3
1 mg as suppository (maximum 3 doses within 24 h) Chest pain, tingling, nausea II

Combination drugs
Acetaminophen + codeine
ASA + codeine + caffeine
ASA + butalbital + caffeine
Varied according to formulation
CNS depression, drowsiness, habituation
III
III
III

*For patients who do not respond to the initial choices, consider a combination medication or ergotamine. Combination medications with a high content of codeine (30 mg) should be used to minimize excessive intake of tablets.
†Use of the antinauseants listed in Table 1 is appropriate for moderate attacks. Metoclopramide alone may relieve all symptoms of the attack.
ISC = subcutaneously, IM = intramuscularly.
§NSAID = nonsteroidal anti-inflammatory drug. Current evidence does not distinguish the relative efficacy of different NSAIDs.
||DHE = dihydroergotamine.
¶Evidence suggests that oral ergot preparations are of limited efficacy and have excessive side effects.

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| CMAJ May 1, 1997 (vol 156, no 9) / JAMC le 1er mai 1997 (vol 156, no 9) |

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Table 2: Medications recommended for moderate migraine attacks*
Medication†	Dosage‡	Main side effects	Level of evidence
NSAID§[22-36] Ibuprofen Naproxen sodium Mefenamic acid	400-800 mg PO q2-6h 275-550 mg PO q2-6h 250-500 mg PO q6h	GI upset GI upset GI upset	I I I
5-HT₁ receptor agonist Selective Sumatriptan[37-47]	50-100 mg PO (may be repeated twice within 24 h) 6 mg SC (may be repeated once within 24 h)	Chest tightness, tingling	I
Non-selective DHE\|\|[47-52]	0.5-1.0 mg SC, IM or IV (may be repeated at 1 h; maximum 4 doses within 24 h)	Chest tightness, tingling, nausea	I
Ergotamine¶[28-32,53]	1-2 mg PO q1h × 3 1 mg as suppository (maximum 3 doses within 24 h)	Chest pain, tingling, nausea	II
Combination drugs Acetaminophen + codeine ASA + codeine + caffeine ASA + butalbital + caffeine	Varied according to formulation	CNS depression, drowsiness, habituation	III III III
*For patients who do not respond to the initial choices, consider a combination medication or ergotamine. Combination medications with a high content of codeine (30 mg) should be used to minimize excessive intake of tablets. †Use of the antinauseants listed in Table 1 is appropriate for moderate attacks. Metoclopramide alone may relieve all symptoms of the attack. ISC = subcutaneously, IM = intramuscularly. §NSAID = nonsteroidal anti-inflammatory drug. Current evidence does not distinguish the relative efficacy of different NSAIDs. \|\|DHE = dihydroergotamine. ¶Evidence suggests that oral ergot preparations are of limited efficacy and have excessive side effects.