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Author: Admin | 2025-04-28
Used, but the evidence supporting its effectiveness is contradictory.34–36 Diphenhydramine (Benadryl) is not recommended.37 Parenteral corticosteroids (e.g., intravenous dexamethasone) with or without tapered oral corticosteroids can be considered to help decrease headache recurrence.12,29,31 Opioids can be considered for refractory migraine but should be used sparingly and infrequently.12,31 Special Considerations CHILDREN AND ADOLESCENTS Evidence for effective treatment of migraine is weaker in children than in adults; studies have high placebo response rates and lack precision and consistency.38,39 In studies of acetaminophen and NSAIDs, ibuprofen produced the best results. All triptans except frovatriptan have been studied in children and adolescents.38,39 Three are approved by the U.S Food and Drug Administration for use in this population: almotriptan (for children and adolescents 12 to 17 years of age), rizatriptan (six to 17 years), and sumatriptan in combination with naproxen (12 years and older).40 Although sumatriptan nasal spray is not approved for use in children, it has shown the greatest benefit in studies of children with migraine, and the American Academy of Neurology recommends it for use in adolescents 12 years and older.41,42 PREGNANCY AND LACTATION Acetaminophen and metoclopramide are the only treatments for migraine that are considered safe in pregnancy. Observational studies have shown no association between triptan use in the first trimester and fetal malformation or adverse pregnancy outcomes.12,43 Triptan use in the second and third trimesters is associated with increased risk of uterine atony and increased blood loss during labor and delivery.43 Although controversial, triptans can be considered for use in pregnant women with debilitating migraines when the potential benefits outweigh the risks. Medications considered safe during lactation include acetaminophen, ibuprofen, metoclopramide, droperidol, prochlorperazine, diphenhydramine, and sumatriptan.12 Aspirin should be avoided during pregnancy and lactation.12 CONTRAINDICATIONS TO VASOCONSTRICTORS Triptans and other vasoconstrictors are contraindicated in patients with coronary artery disease and in specific migraine syndromes, such as hemiplegic and basilar migraines. Nonopioid combination analgesics, especially acetaminophen/aspirin/caffeine, are most helpful in patients with these conditions.12 NSAIDs and dopamine antagonists can also be considered.12 Data Sources: A PubMed search was completed in Clinical Queries using the key terms migraine, acute, and treatment. The search
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