Migraine Without Aura When Oral Analgesics or NSAIDs Have Not Achieved Adequate Relief
Not all migraine attacks respond to first-line oral analgesics or non-steroidal anti-inflammatory drugs (NSAIDs). When headache is not meaningfully reduced within 2 hours of initial therapy, a structured next-line approach is indicated.
Initial treatment with oral analgesics or NSAIDs — options include ASA, ibuprofen, metamizole, diclofenac potassium, combination analgesics, or paracetamol, with antiemetics such as metoclopramide or domperidone for nausea — did not achieve the required goal: reduction of headache within 2 hours of administration.
This protocol involves triptan therapy — a class of selective serotonin receptor agonists. Within this class, options differ in speed of onset and duration of action, and the choice is guided by these characteristics. Timing of administration during the attack is a clinically important factor. The complete regimen, including all options, selection criteria, and re-dosing guidance, is detailed in the full protocol.
Freedom from pain or meaningful reduction of headache within 2 hours of administration.
References
DOI: 10.1177/2514183X1882337
- The serotonin (5-HT)1B/1D-receptor agonists (so-called triptans) almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan and zolmitriptan are the therapy of first choice in moderate and severe migraine attacks which are not or only insufficiently responsive to therapy with analgesics or non-steroidal anti-inflammatory drugs (NSAIDs).
- Sumatriptan subcutaneous injection (6 mg) is the most effective therapy of acute migraine attacks.
- Eletriptan and rizatriptan are the most effective oral triptans according to results of meta-analyses.
- Triptans are more effective if taken early in the migraine attack or when the headache is still mild.
- If headache recurs after initial effectiveness of a triptan, a second dose of the triptan may not be given for at least 2 h.
- 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%).