Update on Management of Acute Migraine

Abstract

Review recent literature related to the acute management of migraine headache. For initial treatment of acute migraine, research supports established treatments, particularly antidopaminergic medications and ketorolac and avoidance of opioids, which appears consistent with evaluation of current practice trends. New data supports the safety of triptans in pregnant patients and those with cardiovascular disease. Study of propofol and ketamine has not defined a role for use in the acute setting, and regional anesthesia has emerged as a potentially useful treatment option, though study has been limited. CGRP antagonists are promising new medications undergoing current study. There is opportunity to improve acute migraine care through recognition of unmet medical needs and improved communication. Antidopaminergic antiemetics, triptans, and NSAIDs remain the mainstay of acute treatment. Other reviewed medications lack strong evidence and may be considered case-to-case.