What Is the First-Line Acute Treatment for Migraine with Brainstem Aura?

This protocol covers first-line acute management of mild to moderate attacks of migraine with brainstem aura. Effective treatment targets prompt headache relief, with management also addressing accompanying symptoms when present.

Clinical Context

The protocol is indicated for mild to moderate attack severity. Where nausea or vomiting accompanies the headache, this requires specific consideration alongside analgesic management.

Treatment Approach (partial overview)

Initial management relies on oral analgesic and anti-inflammatory agents. When nausea or vomiting is present, an anti-emetic agent can be incorporated. The complete protocol — including agent selection criteria, the sequencing algorithm, and the full decision tree for contraindicated situations — is available via the link below.

Clinical Goal

The primary measure of treatment success is meaningful headache reduction at 2 hours after medication intake.

2-hour headache reduction

Instant Access to Structured Evidence-Based Regimens

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.
Analgesics and NSAIDs are effective in the treatment of acute migraine attacks.
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.
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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