This page outlines the first-line management approach for hemiplegic migraine, covering treatment of mild to moderate attacks and the key clinical target: meaningful pain relief within 2 hours.
The primary objective of treatment is reduction of headache — ideally complete freedom from pain — within 2 hours of taking the initial medication.
Mild to moderate attacks are managed initially with oral analgesic or anti-inflammatory agents. When nausea or vomiting accompanies the attack, anti-emetic therapy is incorporated into the regimen.
Analgesics like acetylsalicylic acid and non-steroidal anti-inflammatory drugs (NSAIDs) are effective in the treatment of migraine.
Mild and moderate migraine attacks should be treated initially with these substances.
Anti-emetics like metoclopramide or domperidone are effective in the treatment of nausea and vomiting during a migraine attack.
The reduction of headache after 2 h, the most important parameter in clinical studies for the efficacy of migraine medications, is greatest following subcutaneous administration of sumatriptan (70–80%).
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