Migraine headache is a serious and very common health problem. According to American Headache association, about 36 million Americans suffer from migraines. The main treatment of migraine attack is pharmacotherapy, for which many drugs are available. Only evidence-based guidelines can help in determining which drugs are more helpful than others.

Members of the guideline committee of American Headache Society (AHS), conducted an assessment of effectiveness of drugs for migraine headache. This study, which is published in the January issue of the journal “Headache”, will form the basis of new American Headache Society guidelines for the treatment of acute migraine.

“Several large, randomized acute pharmacological migraine treatment trials have been conducted since the release of the 2000 AAN/AHS guidelines, so it was important that we update our guidelines to reflect the latest evidence.” said Dr. Silberstein. He is a professor of neurology and director of the Jefferson Headache Center of Thomas Jefferson University in Philadelphia.

The researchers conducted a systematic review of clinical trials on the efficacy of acute migraine treatments vs. placebo. The review was based on those original articles which were published between 1998 and 2013. After reading the abstract, researcher decided whether the full manuscript qualified for review or not. Each article reviewed was then rated on a number of factors that reflected study rigor and significance, as well as findings.

Each drug class was subsequently categorized in different levels. Level A includes those drug classes which are found to be effective for migraine headache. Drugs which are probably effective are in class B and possibly effective drugs are in class C. Another category (Level U) is created for those drug classes, which lack evidence regarding their effectiveness.

Medications specific for acute migraine headache, like triptans and dihydroergotamine (nasal spray, inhaler) are effective (Level A). Ergotamine and other forms of dihydroergotamine are probably effective (Level B). The antiemetics prochlorperazine, droperidol, chlorpromazine, and metoclopramide are probably effective (Level B). Octreotide is probably not effective (Level B)

Non-specific medications like acetaminophen, NSAIDs, opioids (butorphanol nasal spray), sumatriptan/naproxen, and the combination of acetaminophen/aspirin/caffeine are also effective (Level A). Several other non-specific medications are classified as “probably effective” or “possibly effective”.

It should be kept in mind that review focuses only on the treatment of acute migraine attacks. Authors also noted that clinicians still need to individualize treatment depending on clinical context of the migraine attack. Moreover, doctors should also consider the effectiveness and potential side effects while selecting a suitable medication.



Michael J. Marmura, Stephen D. Silberstein, Todd J. Schwedt. The Acute Treatment of Migraine in Adults: The American Headache Society Evidence Assessment of Migraine Pharmacotherapies. Headache, January 2015 DOI:10.1111/head.12499