Migraine and Headache Treatments

MIGRAINE AND HEADACHE TREATMENTS
Generic	Strength	Brand		Form	Dose
TREATMENT
Analgesic + Barbiturate
acetamin– ophen	325mg	—	Rx	caps, tabs	Adults: 1–2 tabs or caps every 4hrs as needed; max 6/day. Children: Not established.
butalbital	50mg
caffeine	40mg
acetamin– ophen	300mg	—	Rx	caps	Adults: 1–2 caps every 4hrs as needed; max 6 caps/day. Children: Not established.
butalbital	50mg
caffeine	40mg
acetamin– ophen	325mg	—	Rx	tabs	Adults: 1–2 tabs every 4hrs; max 6 tabs/day. Children: Not recommended.
butalbital	50mg	—	Rx	tabs
Analgesic + Barbiturate + Opioid
acetamin– ophen	325mg	Fioricet w. Codeine	CIII	caps	Adults: 1–2 caps every 4hrs as needed; max 6 caps/day. Children: Not established.
butalbital	50mg
caffeine	40mg
codeine phosphate	30mg
Analgesic + Salicylate
acetamin– ophen	250mg	Bayer Migraine Formula	OTC	caplets	≥18yrs: 2 caplets with a glass of water; max 2 caplets/24hrs. <18yrs:: Not recommended.
aspirin	250mg
caffeine	65mg
acetamin– ophen	250mg	Excedrin Migraine	OTC	caplets	≥18yrs: 2 caplets with a glass of water; max 2 caplets/24hrs. <18yrs:: Consult physician.
aspirin	250mg
caffeine	65mg
Barbiturate + Salicylate
aspirin	325mg	Fiorinal	CIII	caps	Adults: 1–2 caps every 4hrs as needed; max 6 caps/day. Children: Not established.
butalbital	50mg
caffeine	40mg
Barbiturate + Salicylate + Opioid
aspirin	325mg	Fiorinal w. Codeine	CIII	caps	Adults: 1–2 caps every 4hrs as needed; max 6 caps/day. Children: Not established.
butalbital	50mg
caffeine	40mg
codeine phosphate	30mg
Calcitonin Gene-Related Peptide (CGRP) Receptor Antagonist
rimegepant	75mg	Nurtec ODT	Rx	ODT	Adults: 75mg once (max daily dose). The safety of treating more than 15 migraines in a 30-day period has not been established. Children: Not established.
ubrogepant	50mg, 100mg	Ubrelvy	Rx	tabs	Adults: Initially 50mg or 100mg; may give a second dose ≥2hrs after initial dose (max 200mg/day). The safety of treating more than 8 migraines in a 30-day period has not been established. Children: Not established.
Ergot Alkaloid
dihydro– ergotamine mesylate	1mg/mL	D.H.E. 45	Rx	IM, IV, or SC inj	Adults: 1mL IV at 1hr intervals; max 2 doses/day. Or, 1mL IM or SC at 1hr intervals; max 3 doses/day. For all: max 6 doses/wk. Not for chronic use. Children: Not recommended.
dihydro– ergotamine mesylate	4mg/mL	Migranal	Rx	nasal spray †	Adults: 1 spray in each nostril, repeat 15mins later; max 6 sprays/24hrs and 8 sprays/wk. Children: Not recommended.
ergotamine tartrate	1mg	—	Rx	tabs	Adults: 2 tabs at onset of attack, then 1 tab every ½hr if needed; max 6 tabs/attack, 10 tabs/wk. Children: Not recommended.
caffeine	100mg	—	Rx	tabs
ergotamine tartrate	2mg	—	Rx	rectal supp	Adults: 1 supp rectally at onset of attack, then 1 supp after 1hr if needed; max 2 supps/attack, 5 supps/wk. Children: Not recommended.
caffeine	100mg	—	Rx	rectal supp
Non-Steroidal Anti-inflammatory (NSAID)
diclofenac potassium	50mg	Cambia	Rx	buffered pwd for oral soln*	≥18yrs: Mix 1 packet (50mg) with 30–60mL of water only and drink immediately. Not interchangeable with other forms of diclofenac. <18yrs: Not recommended.
ibuprofen	200mg	Advil Migraine	OTC	liq-filled caps	≥18yrs: Usually 400mg once daily. <18yrs: Not recommended.
ibuprofen	200mg	Motrin Migraine Pain	OTC	caplets	≥18yrs: Usually 200–400mg once daily. <18yrs: Not recommended.
Selective 5-HT_1B/1D Receptor Agonist
almotriptan (as malate)	6.25mg, 12.5mg	—	Rx	tabs	≥12yrs: 6.25–12.5mg single dose; may repeat once after 2hrs; max 25mg/24hrs. Hepatic impairment, CrCl 10–30mL/min, or concomitant potent CYP3A4 inhibitors: initially 6.25mg once; max 12.5mg/24hrs. The safety of treating an average of more than 4 migraines over 30 days is not established. <12yrs: Not established.
eletriptan HBr	20mg, 40mg	Relpax	Rx	tabs	≥18yrs: 20mg or 40mg once. May repeat once after 2hrs; max 80mg/day. The safety of treating an average of more than 3 headaches in a 30-day period has not been established. <18yrs: Not established.
frovatriptan (as succinate)	2.5mg	Frova	Rx	tabs	≥18yrs: 2.5mg with fluids; may repeat once after 2hrs; max 7.5mg/24hrs. The safety of treating an average of more than 4 headaches in a 30-day period has not been established. <18yrs: Not recommended.
naratriptan HCl	1mg, 2.5mg	Amerge	Rx	tabs	≥18yrs: 1mg or 2.5mg with fluids; may repeat once after 4hrs; max 5mg/24hrs. The safety of treating, on average, more than 4 headaches in a 30-day period has not been established. Mild-to-moderate renal/hepatic impairment: initially 1mg; max 2.5mg/24hrs. <18yrs: Not recommended.
rizatriptan (as benzoate)	10mg	Maxalt	Rx	tabs	≥18yrs: Initially 5 or 10mg; may repeat after 2hrs; max 30mg/24hrs. Concomitant propranolol: 5mg; max 15mg/24hrs. The safety of treating, on average, more than 4 headaches in a 30-day period has not been established. <6yrs: Not established. 6–17yrs (<40kg): 5mg; (≥40kg): 10mg. Concomitant propranolol (≥40kg only): max 5mg/24hrs. The efficacy and safety of treating with ≥1 dose/24hrs have not been established.
rizatriptan (as benzoate)	10mg	Maxalt-MLT	Rx	ODT*
sumatriptan	4mg/ 0.5mL, 6mg/ 0.5mL	Imitrex Injection	Rx	SC inj	≥18yrs: 6mg SC (may start at lower dose if 6mg not tolerated). May repeat after 1hr; max two 6mg doses in 24hrs. <18yrs: Not recommended.
	5mg/ spray, 20mg/ spray	Imitrex Nasal Spray	Rx	nasal spray	≥18yrs: 5mg, 10mg, or 20mg once. May repeat once after 2hrs; max 40mg/day. The safety of treating an average of more than 4 headaches in a 30-day period has not been established. <18yrs: Not recommended.
	25mg, 50mg, 100mg	Imitrex Tablets	Rx	tabs	≥18yrs: 25–100mg once, swallow whole with fluids as soon as possible after migraine onset; may repeat dose at intervals of at least 2hrs, max 200mg/day; or single-dose tablets up to 100mg/day if injection has been used. The safety of treating an average of more than 4 headaches in a 30-day period has not been established. <18yrs: Not recommended.
	11mg	Onzetra Xsail	Rx	caps for nasal inh	≥18yrs: 1 nosepiece (11mg) in each nostril (22mg total), using Xsail delivery device. May repeat once after ≥2hrs; max 44mg (4 nosepieces)/day or one dose of Onzetra Xsail and one dose of another sumatriptan product separated by ≥2hrs. The safety of treating an average of more than 4 headaches in a 30-day period has not been established. <18yrs: Not established.
	10mg	Tosymra	Rx	nasal spray	≥18yrs: 10mg as single spray in one nostril. Reevaluate if no response. Max cumulative dose: 30mg in 24hrs with each dose separated by ≥1hr. May also be given ≥1hr after another sumatriptan product. <18yrs: Not recommended.
	3mg/0.5mL	Zembrace Symtouch	Rx	soln for SC inj	≥18yrs: 3mg SC. May repeat after ≥1hr; max 12mg in 24hrs. May also be given ≥1hr after another sumatriptan product. <18yrs: Not recommended.
zolmitriptan	2.5mg+, 5mg	Zomig	Rx	tabs	≥18yrs: Initially 1.25–2.5mg; max recommended single dose: 5mg. If headache returns, may repeat after 2hrs; max 10mg/day. The safety of treating an average of more than 3 headaches in a 30-day period has not been established. Concomitant cimetidine: max single dose: 2.5mg, not to exceed 5mg in 24-hr period. <18yrs: Not recommended.
	5mg/ spray	Zomig Nasal Spray	Rx	nasal spray	≥18yrs: 5mg once. If headache returns, may repeat once after 2hrs; max 10mg/day. The safety of treating an average of more than 4 headaches in a 30-day period has not been established. <18yrs: Not recommended.
	2.5mg, 5mg	Zomig-ZMT	Rx	ODT*	≥18yrs: Initially 1.25–2.5mg; max recommended single dose: 5mg. If headache returns, may repeat after 2hrs; max 10mg/day. The safety of treating an average of more than 3 headaches in a 30-day period has not been established. Concomitant cimetidine: max single dose: 2.5mg, not to exceed 5mg in 24-hr period. <18yrs: Not recommended.
Selective 5-HT_1B/1D Receptor Agonist + Non-Steroidal Anti-Inflammatory (NSAID)
sumatriptan succinate/ naproxen sodium	85/ 500mg	Treximet	Rx	tabs	≥12yrs: 1 tab (85/500mg) once; may repeat once after 2hrs; max 2 tabs/day. Mild-to-moderate hepatic impairment: 1 tab (10/60mg)/day. The safety of treating an average of more than 5 migraines in a 30-day period has not been established. <12yrs: Not established. 12–17yrs: 1 tab (10/60mg) once; max 1 tab (85/500mg)/day. The safety of treating an average of more than 2 migraines in a 30-day period has not been established.
Selective 5-HT_1F Receptor Agonist
lasmiditan	50mg, 100mg	Reyvow	Rx	tabs	Adults: 50–200mg once as needed; max 1 dose/24hrs. The safety of treating an average of >4 migraines in a 30-day period has not been established. Children: Not established.
PROPHYLAXIS
Calcitonin Gene-Related Peptide (CGRP) Receptor Antagonist
eptinezumab-jjmr	100mg/mL	Vyepti	Rx	soln for IV infusion after dilution	Adults: Infuse over 30mins. 100mg every 3mos; some patients may benefit from 300mg every 3mos. Children: Not established.
erenumab-aooe	70mg/mL, 140mg/mL	Aimovig	Rx	soln for SC inj	Adults: 70mg SC once monthly; some patients may benefit from 140mg monthly. Children: Not established.
fremanezumab-vfrm	225mg/1.5mL	Ajovy	Rx	soln for SC inj	Adults: 225mg SC once monthly or 675mg (three 225mg inj) every 3mos. Children: Not established.
galcanezumab-gnlm	100mg/mL, 120mg/mL	Emgality	Rx	soln for SC inj	Migraine: initially 240mg SC loading dose (two 120mg inj), followed by 120mg monthly. Cluster headache: 300mg (three 100mg inj) SC at the onset of the cluster period, then monthly until the end of the cluster period. Children: Not established.
NOTES
Key: ODT = orally disintegrating tablets; soln = solution; supp = suppositories; + = scored tablets *contains phenylalanine; †contains caffeine Not an inclusive list of medications, official indications and/or dosages. Please see drug monograph at www.eMPR.com, contact company for full drug labeling and/or consult your healthcare provider. (Rev. 5/2020)

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