Acute treatment of migraine headache

The purpose of this article is to provide practitioners with the tools necessary to diagnose and treat acute migraine. The current diagnostic criteria for migraine are outlined. Pearls to distinguish migraine from the other primary headaches, such as tension-type headache and cluster headache, are provided. The importance of the headache history, plus indications for neuroimaging, are presented. Readers will be taught how to take an effective headache history. General principles of treatment, including appropriate medication selection, medication dosing and route of administration, medication contraindications, drug interactions, and tips to optimize success are covered. A stratified care plan is outlined. Acute migraine treatment options are discussed, including dosing, side effects, and summary recommendations for simple analgesics, combination analgesics, opiates, corticosteroids, and the migraine specific ergots and triptans. The 7 available triptans are covered in detail and tips for selecting the most appropriate triptan for specific situations are delineated. Preventative and future treatments are briefly discussed.