Clinical Scenario

For mild to moderate migraine without aura attacks, a structured first-line approach using oral analgesics and anti-inflammatory agents is indicated. When attacks are accompanied by nausea or vomiting, additional targeted treatment may be appropriate.

Treatment Approach (partial overview)

Initial management involves oral analgesics and non-steroidal anti-inflammatory drugs (NSAIDs), with anti-emetic agents considered for attacks accompanied by significant nausea or vomiting — the full protocol defines which options apply, under what conditions, and what to use when standard agents are contraindicated.

References

DOI: 10.1177/2514183X1882337

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.
Prokinetic and anti-emetic medications should generally not be combined with analgesics or triptans but used for targeted treatment of severe nausea or vomiting.
In a randomized-controlled trial (RCT), no significant difference could be observed between the dosages 200 mg, 400 mg and 600 mg ibuprofen for the primary endpoint headache reduction 2 h after taking the medication.

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First-Line Analgesic and NSAID Treatment for Migraine Without Aura

References