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
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
aspirin 500mg Bayer Headache OTC caplets ≥12yrs: 2 caplets with a glass of water every 6hrs; max 8 caplets/24hrs.
<12yrs: consult physician.
caffeine 32.5mg
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 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
galcanezumab-gnlm 100mg/mL, 120mg/mL Emgality Rx soln for SC inj Adults: Cluster headache: 300mg (three 100mg inj) at the onset of the cluster period, then monthly until the end of the cluster period.
Children: Not established.
rimegepant 75mg Nurtec ODT
Rx ODT Adults: 75mg once as needed (max daily dose). The safety of using more than 18 doses 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.
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.
4mg/mL Trudhesa Rx nasal spray Adults: 1 spray in each nostril, may repeat at least 1hr later if needed; max 2 doses (4 sprays) within 24hrs or 3 doses (6 sprays) within 7 days.
Children: Not established.
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
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
Non-Steroidal Anti-inflammatory (NSAID)
celecoxib 25mg/mL Elyxyb Rx oral soln Adults: 120mg (4.8mL) once. Max: 120mg/day. Use for the fewest number of days per month, as needed.
Children: Not established.
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.
Selective 5-HT1B/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.
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-HT1B/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-HT1F Receptor Agonist
lasmiditan 50mg, 100mg Reyvow CV 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
Antiepileptic Drugs
divalproex sodium 125mg, 250mg, 500mg Depakote Rx del-rel tabs Adults: Initially 250mg twice daily; usual max 1g/day. Elderly: reduce initial dose and titrate slowly; monitor. Concomitant rufinamide: initiate at a low dose and titrate.
Children: Not recommended.
250mg, 500mg Depakote ER Rx ext-rel tabs Adults: 500mg once daily for 1 week, then 1g once daily. Elderly: reduce initial dose and titrate slowly; monitor. Concomitant rufinamide: initiate at a low dose and titrate.
Children: Use other forms.
topiramate 15mg, 25mg Topamax Capsules Rx coated beads in caps ≥12yrs: Titrate at 1-wk intervals to target dose of 100mg/day. Initially 25mg once daily in the PM, then 25mg twice daily, then 25mg in the AM and 50mg in the PM, then 50mg twice daily.
<12yrs: Not established.
25mg, 50mg, 100mg, 200mg Topamax Rx tabs
25mg/mL Eprontia Rx oral soln Adults: Initially 25mg once daily in the PM, then 25mg twice daily, then 25mg in the AM and 50mg in the PM, then to target dose 50mg twice daily. Titrate at 1wk intervals.
Children: Not established.
Beta-Blockers
propranolol 10mg, 20mg, 40mg, 60mg, 80mg Inderal Rx scored tabs Adults: Initially 80mg daily in divided doses. Usual range: 160–240mg/day. Discontinue if poor result after 4–6wks.
Children: Not recommended.
60mg, 80mg, 120mg, 160mg Inderal LA Rx sust-rel caps
timolol 5mg, 10mg+, 20mg+ Rx tabs Adults: Initially 10mg twice daily. Increase weekly if needed; max 30mg daily in 2 divided doses. Evaluate at 6–8 wks.
Children: Not recommended.
Calcitonin Gene-Related Peptide (CGRP) Receptor Antagonist
atogepant 10mg, 30mg, 60mg Qulipta Rx tabs Adults: Episodic migraine: 10mg, 30mg, or 60mg once daily.
Children: Not established.
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 Adults: Initially 240mg SC loading dose (two 120mg inj), followed by 120mg monthly.
Children: Not established.
rimegepant 75mg Nurtec ODT Rx ODT Adults: Episodic migraine: 75mg every other day. The safety of using more than 18 doses in a 30-day period has not been established.
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. 6/2022)