What Is the First-Line Treatment for Migraine with Aura?
Migraine with aura (ICD-11 8A80.1 / ICD-10 G43.1) involves episodic headache attacks, often preceded by neurological symptoms. The first-line treatment strategy is structured around attack severity and individual tolerability.
For mild to moderate attacks, the initial approach centres on analgesics and anti-inflammatory medications. When nausea or vomiting accompany the attack, targeted anti-emetic management is incorporated alongside the primary treatment.
Treatment approach
The first-line regimen involves oral analgesics and NSAIDs as the primary agents, with anti-emetic support for associated symptoms. Specific agent selection, sequencing, and alternatives for patients with contraindications are detailed in the full protocol — the complete regimen is not shown here.
Clinical goal: headache reduction at 2 hours
References
- 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.
- The effectiveness has been best demonstrated for ASA and ibuprofen.
- Anti-emetics like metoclopramide or domperidone are effective in the treatment of nausea and vomiting during a migraine attack.
- Can be used in patients with contraindications for NSAIDs
- 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%).
DOI: 10.1177/2514183X1882337
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