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The primary goal of treatment for migraine headache is the immediate relief of the acute headache, also called abortive treatment. It is crucial that abortive treatment begin as early as possible after the headache begins since the longer one waits, the more difficult it is for treatment to be effective. Treatment for acute headache includes:

• Nonpharmacologic or supportive strategies
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Migraine-specific medications
• Rescue medications

Nonpharmacologic or Supportive Strategies

When a person feels a migraine headache beginning, there are various steps they can take to minimize or reduce the intensity of the headache, including:

• Remove yourself from any stressful situation
• Lie down in a cool, dark, quiet place
• Place a cool wet cloth on the forehead
• Take medication for nausea if needed, such as prochlorperazine (Compazine) which comes as an oral or suppository formulation; or metoclopramide (Reglan) which comes in tablet form

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) such as aspirin, acetaminophen (Tylenol), ibuprofen (Advil) or naproxen (Aleve) areanalgesic drugs (pain relievers) and are typically the first-line medications for moderate migraine headaches but not for severe headaches. Most NSAIDs are available over-the-counter (OTC) without a prescription. They can be taken individually or in combination and are typically taken at higher doses than for an average, non-migraine headache.

Side effects of NSAIDs when taken at high doses for an extended period of time include:

• Abdominal pain
• Bleeding
• Ulcers
• Rebound headaches, if taken more than 2-3 times a week or in very large doses. The medication itself becomes the cause of rebound headaches.

The U.S. Food and Drug Administration has approved the following three OTC medications for migraine headache:

• Excedrin Migraine
• Advil Migraine
• Motrin Migraine

Prescription NSAIDs may also be helpful, however, they may cause adverse abdominal side effects at the high doses necessary for efficacy of aborting a migraine headache.

Migraine-Specific Medications

Migraine-specific drugs block the underlying mechanism of migraine headache. They are considered serotonin receptor agonists which means that they bind to the receptors in the brain cells that regulate the release of serotonin. Reduced levels of serotonin result in dilation of the blood vessels which causes the headache pain. Triptans effectively break the cycle of the migraine.

Abortive migraine-specific medications include:

• Triptans
• Ergotamines and ergot derivatives

Triptans

Several triptans have been approved by the US Food and Drug Administration (FDA) for treatment of acute migraine headache, including:

• Sumatriptan (Imitrex) -available as a nasal spray, rapidly dissolvable pill, or self-injectable formulation
• Rizatriptan (Maxalt) - available as a rapidly dissolvable pill that can be taken without water
• Zolmitriptan (Zomig) - available as a nasal spray
• Eletriptan (Relpax)

Triptans are especially effective for severe headaches that cause significant disability. They relieve pain, nausea, light and sound sensitivity. Certain triptans, such as sumatriptan and zolmitriptan, are efficacious within two hours and have response rates of up to 70%. If a patient responds poorly to one triptan, others should be tried. Migraineurs who suffer from nausea can benefit from the alternate forms of medication delivery (such as nasal spray or injectable formulation).