Table 4 Clinical stratification of acute specific migraine treatments

Clinical situation

Treatment options

Failed analgesics/NSAIDs

First tier

* Sumatriptan 50 mg or 100 mg p.o.

* Rizatriptan 10 mg p.o.

* Almotriptan 12.5 mg

* Zolmitriptan 2.5mg p.o.

Early nausea or difficulties taking tablets

Headache recurrence

Tolerating acute treatments poorly

Early vomiting

Menstrually related headache

Slower effect/better tolerability

* Naratriptan 2.5 mg

* Frovatriptan 2.5 mg

Infrequent headache

* Dihydroergotamine nasal spray 2 mg

Sumatriptan 20 mg nasal spray Zolmitriptan 5 mg nasal spray Rizatriptan 10 mg MLT wafer Zolmitriptan 2.5 mg dispersible

Ergotamine 2 mg (perhaps most effective p.r./usually with caffeine) Naratriptan 2.5 mg p.o. Eletriptan 80 mg

Naratriptan 2.5 mg Frovatriptan 2.5 mg

Sumatriptan 25 mg p,r. Sumatriptan 6 mg s.c.


* Ergotamine p.o. nocte

* Estrogen patches


* Triptans

* Dihydroergotamine nasal spray

Very rapidly developing symptoms

Sumatriptan 6 mg s.c. Dihydroergotamine 1 mg i.m.

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