Migraine and Headache Treatments
| MIGRAINE AND HEADACHE TREATMENTS | |||||
|---|---|---|---|---|---|
| Generic & Class | Brand & Company | Strength | Formulations† | Usual Dose | |
| ANALGESIC + BARBITURATE | |||||
| acetaminophen | DOLGIC PLUS
(Victory Pharma) |
750mg | Rx | tabs | Children: not recommended.
Adults: 1 tab every 4 hrs; max 5 tabs/day. |
| butalbital | 50mg | ||||
| caffeine | 40mg | ||||
| acetaminophen | ESGIC PLUS
(Mikart) |
500mg | Rx | scored tabs; caps | Children: not recommended.
Adults: 1 cap or tab every 4 hours as needed. |
| butalbital | 50mg | ||||
| caffeine | 40mg | ||||
| acetaminophen | FIORICET
(Actavis) |
325mg | Rx | tabs | Children: not recommended.
Adults: 1–2 tabs or caps every 4 hours as needed; max 6/day. |
| butalbital | 50mg | ||||
| caffeine | 40mg | ||||
| acetaminophen | PHRENILIN
(Valeant) |
325mg | Rx | tabs | Children: not recommended.
Adults: 1–2 tabs every 4 hours; max 6 tabs daily. |
| butalbital
|
50mg | ||||
| ANALGESIC + BARBITURATE + OPIOID | |||||
| acetaminophen | FIORICET w. CODEINE
(Actavis) |
325mg | CIII | caps | Children: not recommended.
Adults: 1–2 tabs or caps every 4 hours as needed; max 6/day. |
| butalbital | 50mg | ||||
| caffeine | 40mg | ||||
| codeine phosphate | 30mg | ||||
| ANALGESIC + SALICYLATE | |||||
| acetaminophen | BAYER MIGRAINE FORMULA
(Bayer Consumer) |
250mg | OTC | caplets | Children: not recommended.
Adults: 2 caplets with a glass of water. Max 2 caplets/24 hours. |
| aspirin | 250mg | ||||
| caffeine | 65mg | ||||
| acetaminophen | EXCEDRIN MIGRAINE
(Novartis Consumer Health) |
250mg | OTC | tabs | Children: not recommended.
Adults: Take with full glass of water. ≥18yrs: 2 tabs every 6 hours as needed; max 8 tabs/day for 2 days. |
| aspirin | 250mg | ||||
| caffeine | 65mg | ||||
| ANALGESIC + SYMPATHOMIMETIC | |||||
| acetaminophen | MIGRATEN
(Azur Pharma) |
325mg | Rx | caps | Children: not recommended.
Adults: Tension: 1–2 caps every 4 hours; max 8 caps/day. Migraine: 2 caps at once, then 1 cap every hour until relieved; max 5 caps/12 hours. |
| caffeine | 100mg | ||||
| isometheptene mucate | 65mg | ||||
| BARBITURATE + SALICYLATE | |||||
| aspirin | FIORINAL
(Actavis) |
325mg | CIII | tabs; caps | Children: not recommended.
Adults: 1–2 tabs or caps every 4 hours as needed; max 6/day. |
| butalbital | 50mg | ||||
| caffeine | 40mg | ||||
| BARBITURATE + SALICYLATE + OPIOID | |||||
| aspirin | FIORINAL w. CODEINE
(Actavis) |
325mg | CIII | caps | Children: not recommended.
Adults: 1–2 tabs or caps every 4 hours as needed; max 6/day. |
| butalbital | 50mg | ||||
| caffeine | 40mg | ||||
| codeine phosphate | 30mg | ||||
| ERGOT ALKALOID | |||||
| dihydroergotamine mesylate | D.H.E. 45
(Valeant) |
1mg/mL | Rx | IM, IV, or SC inj | Children: not recommended.
Adults: 1mL IV at 1 hour intervals; max 2 doses/day. Or, 1mL IM or SC at 1-hour intervals; max 3 doses/day. For all: max 6 doses/week. Do not use chronically. |
| MIGRANAL**
(Valeant) |
4mg/mL | Rx | nasal spray | Children: not recommended.
Adults: 1 spray in each nostril, repeat 15 minutes later; max 6 sprays/24 hrs and 8 sprays/wk. |
|
| ergotamine tartrate | (various) | 1mg | Rx | tabs | Children: not recommended.
Adults: 2 tablets at onset of attack, then 1 tablet every ½ hour if needed; max 6 tabs/attack, 10 tabs/week. |
| caffeine | 100mg | ||||
| ergotamine tartrate | (various) | 2mg | Rx | rectal supp | Children: not recommended.
Adults: 1 supp rectally at onset of attack, then 1 supp after 1 hour if needed; max 2 supps/attack, 5 supps/week. |
| caffeine | 100mg | ||||
| NON-STEROIDAL ANTI-INFLAMMATORY (NSAID) | |||||
| diclofenac potassium | CAMBIA
(Nautilus) |
50mg | Rx | Buffered pwd for oral soln | Children: <18yrs: not recommended.
Adults: ≥18yrs: mix 1 packet (50mg) with 30–60mL of water only and drink immediately. |
| ibuprofen | ADVIL MIGRAINE
(Pfizer Consumer Healthcare) |
200mg | OTC | liquid-filled caps | Children: <18yrs: not recommended.
Adults: ≥18yrs: Usually 400mg once daily. |
| MOTRIN MIGRAINE PAIN
(McNeil Consumer & Specialty) |
200mg | OTC | caplets | Children: <18yrs: not recommended.
Adults: ≥18yrs: Usually 200mg–400mg once daily. |
|
| SELECTIVE 5-HT1B/1D RECEPTOR AGONIST | |||||
| almotriptan (malate) | AXERT
(Janssen) |
6.25mg, 12.5mg | Rx | tabs | Adults and Children: <12yrs: not recommended. ≥12yrs: 6.25mg or 12.5mg single dose; may repeat once after 2 hours; max 25mg/24hrs. Hepatic or severe renal impairment (CrCl 10–30mL/minute) or concomitant potent CYP3A4 inhibitors (eg, ketoconazole): initially 6.25mg once; max 12.5mg/24 hours. The safety of treating an average of more than 4 headaches over 30 days is not established. |
| eletriptan HBr | RELPAX
(Pfizer) |
20mg, 40mg | Rx | tabs | Children: <18yrs: not recommended.
Adults: ≥18yrs: 20mg or 40mg once. Reevaluate if no response. May repeat once after 2 hours; max 80mg/day. The safety of treating an average of more than 3 headaches in a 30-day period has not been established. |
| frovatriptan (as succinate) | FROVA
(Endo) |
2.5mg | Rx | tabs | Children: <18yrs: not recommended.
Adults: ≥18yrs: 2.5mg with fluids; may repeat once after 2 hours; max 7.5mg/24 hours. Reevaluate if no response after 1st dose. The safety of treating an average of more than 4 headaches in a 30-day period has not been established. |
| naratriptan HCl | AMERGE
(GlaxoSmithKline) |
1mg, 2.5mg | Rx | tabs | Children: <18yrs: not recommended.
Adults: ≥18yrs: 1mg or 2.5mg with fluids; may repeat once after 4 hours; max 5mg/24 hours. The safety of treating, on average, more than 4 headaches in a 30-day period has not been established. Mild-to-moderate renal or hepatic impairment: consider lower initial dose; max 2.5mg/24 hours. |
| rizatriptan (as benzoate) | MAXALT
(Merck) |
5mg, 10mg | Rx | tabs | Children: <18yrs: not recommended.
Adults: ≥18yrs: Initially 5 or 10mg; may repeat after 2 hrs; max 30mg/day. Concomitant propranolol: use 5mg dose; max 3 doses/day. The safety of treating, on average, more than 4 headaches in a 30-day period has not been established. |
| MAXALT-MLT*
(Merck) |
5mg, 10mg | Rx | ODT | ||
| sumatriptan (as succinate) | ALSUMA
(Meridian Med Tech) |
6mg/0.5mL | Rx | soln for SC inj | Children: <18yrs: not recommended.
Adults: ≥18yrs: one (6mg) dose SC to the lateral thigh or upper arm only. Reevaluate if no response. May repeat after 1 hour; max two (6mg) doses in 24 hours. |
| IMITREX INJECTION
(GlaxoSmithKline) |
4mg/0.5mL, 6mg/0.5mL | Rx | SC inj | Children: <18yrs: not recommended.
Adults: ≥18yrs: 6mg SC (may start at lower dose if 6mg not tolerated). Reevaluate if no response. May repeat after 1 hour; max two 6mg doses in 24 hours. |
|
| IMITREX NASAL SPRAY
(GlaxoSmithKline) |
5mg per spray, 20mg per spray | Rx | nasal spray | Children: <18yrs: not recommended.
Adults: ≥18yrs: 5mg, 10mg, or 20mg once. Reevaluate if no response. 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. |
|
| IMITREX TABLETS
(GlaxoSmithKline) |
25mg, 50mg, 100mg | Rx | tabs | Children: <18yrs: not recommended.
Adults: ≥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. Hepatic dysfunction: max 50mg/dose. The safety of treating an average of more than 4 headaches in a 30-day period has not been established. |
|
| SUMAVEL DOSEPRO
(Zogenix) |
6mg/0.5mL | Rx | soln for SC inj | Children: <18yrs: not recommended.
Adults: ≥18yrs: one DosePro (6mg) SC to the abdomen or thigh only. Reevaluate if no response. May repeat after 1 hour; max two DosePro (6mg) doses in 24 hours. |
|
| zolmitriptan | ZOMIG
(Impax) |
2.5mg+, 5mg | Rx | tabs | Children: <18yrs: not recommended.
Adults: ≥18yrs: Initially 1.25–2.5mg; max recommended single dose: 5mg. If headache returns, may repeat after 2 hrs; max 10mg/day. Reevaluate if no response after 1st dose. The safety of treating an average of more than 3 headaches in a 30-day period has not been established. Moderate to severe hepatic impairment: 1.25mg; severe hepatic impairment: max 5mg/day. Concomitant cimetidine: max single dose: 2.5mg, not to exceed 5mg in 24hr period. ZMT: dissolve on tongue and swallow without water. |
| ZOMIG NASAL SPRAY
(Impax) |
5mg per spray | Rx | nasal spray | Children: <18yrs: not recommended.
Adults: ≥18yrs: 5mg once. If headache returns, may repeat once after 2 hrs; max 10mg/day. Reevaluate if no response after 1st dose. The safety of treating an average of more than 4 headaches in a 30-day period has not been established. Moderate to severe hepatic impairment: use alternate formulation. |
|
| ZOMIG-ZMT*
(Impax) |
2.5mg, 5mg | Rx | ODT | Children: <18yrs: not recommended.
Adults: ≥18yrs: Initially 1.25–2.5mg; max recommended single dose: 5mg. If headache returns, may repeat after 2 hrs; max 10mg/day. Reevaluate if no response after 1st dose. The safety of treating an average of more than 3 headaches in a 30-day period has not been established. Moderate to severe hepatic impairment: 1.25mg; severe hepatic impairment: max 5mg/day. Concomitant cimetidine: max single dose: 2.5mg, not to exceed 5mg in 24hr period. ZMT: dissolve on tongue and swallow without water. |
|
| SELECTIVE 5-HT1B/1D RECEPTOR AGONIST + NON-STEROIDAL ANTI-INFLAMMATORY (NSAID) | |||||
| sumatriptan (as succinate) | TREXIMET
(GlaxoSmithKline) |
85mg | Rx | tabs | Children: not recommended.
Adults: Swallow whole. 1 tab once; may repeat once after 2 hours; max 2 tabs/day. The safety of treating an average of more than 5 migraines in a 30-day period has not been established. |
| naproxen sodium | 500mg | ||||
| NOTES | |||||
|
* = contains phenylalanine ** = contains caffeine + = scored tablets † tabs = tablets; caps = capsules; inj = injection; ODT = orally disintegrating tablets; soln = solution; supp = suppositories; IM = intramuscular; IV = intravenous; SC = subcutaneous Not an inclusive list. Please see drug monograph or visit www.eMPR.com. (Rev. 4/2013) |
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