Acute Treatments for Episodic Migraine

In this systematic review, the Agency for Healthcare Research and Quality (AHRQ) evaluated the effectiveness and comparative effectiveness of pharmacologic and nonpharmacologic therapies for the acute treatment of episodic migraine in adults.

Researchers found that:

• Compared with placebo, triptans, NSAIDs (nonsteroidal anti-inflammatory drugs), dihydroergotamine, antiemetics, and acetaminophen reduce pain, but increase the risk of mild and transient adverse events
• Only a small number of studies have evaluated opioids. Some opioids may reduce pain of episodic migraine. Some opioids may be less effective than other drugs.
• No studies evaluated instruments for predicting the risk of opioid misuse, opioid use disorder or overdose, or evaluate risk mitigation strategies to be used when prescribing opioids for episodic migraine
• Newer therapies, like calcitonin gene-related peptide receptor antagonists and lasmiditan (5-HT1F receptor agonist), probably improve pain relief at 2 hours and increase the likelihood of being pain-free at 2 hours, 1 day, and at 1 week, and restore function
• Serious adverse events are more common in patients who received lasmiditan than placebo

Researchers also found that several treatments may improve migraine pain compared with placebo, but that the evidence is insufficient to draw conclusions about serious adverse events. For example:

• Therapies like dexamethasone, dipyrone, lidocaine, magnesium sulfateoctreotide, and secobarbital
• Nonpharmacological treatments like noninvasive neuromodulation devices (e.g., remote electrical neuromodulation), magnetic stimulation, and external trigeminal nerve stimulation
• Other therapies like acupuncture, chamomile oil, and eye movement desensitization reprocessing