Migraine is a complex neurological disorder characterised by recurrent episodes of moderate-to-severe headache typically accompanied by nausea, photophobia, and phonophobia, often with aura. Effective pharmacological treatment is divided into acute (abortive) therapy — taken at the onset of a migraine attack — and preventive (prophylactic) therapy — taken daily to reduce attack frequency and severity.
The most important class of acute migraine-specific medications is the triptans — serotonin 5-HT1B/1D receptor agonists that constrict dilated intracranial blood vessels and inhibit the trigeminal nerve pain pathway. They are prescription-only. OTC options for mild-to-moderate migraine include acetaminophen + aspirin + caffeine combination (Excedrin Migraine), which is FDA-approved specifically for migraine but is less effective for severe attacks.
Migraine Medications Available at Lucas Clinic
- Imitrex (Sumatriptan) — first-in-class triptan; 25/50/100 mg tablets, nasal spray, and subcutaneous injection; acute migraine with or without aura
Understanding Migraine Treatments
Triptans are effective for aborting a migraine attack if taken early — ideally at the first onset of head pain, not during the aura phase for best results. If one triptan is ineffective or causes side effects, switching to a different triptan (there are seven FDA-approved) often succeeds because members of the class differ in bioavailability, half-life, and route of administration.
Preventive therapy is considered for patients with four or more migraine days per month, or migraines significantly impacting quality of life. Preventive agents include beta-blockers (propranolol, metoprolol), amitriptyline, topiramate, valproate, and the newer CGRP monoclonal antibodies (erenumab/Aimovig, fremanezumab/Ajovy, galcanezumab/Emgality) approved since 2018.