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
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
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.
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)
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.
200mg Motrin Migraine Pain OTC caplets ≥18yrs: Usually 200–400mg once daily.
<18yrs: Not recommended.
Selective 5-HT1B/1D Receptor Agonist
almotriptan
(malate)
6.25mg, 12.5mg Axert 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)
5mg, 10mg Maxalt Rx tabs ≥18yrs: Initially 5 or 10mg; may repeat after 2hrs; max 30mg/day. Concomitant propranolol: 5mg; max 3 doses/day. The safety of treating, on average, more than 4 headaches in a 30-day period has not been established.
<18yrs: Not recommended.
5mg, 10mg Maxalt-MLT Rx ODT*
sumatriptan
(as succinate)
6mg/
 
0.5mL
Alsuma Rx soln for SC inj ≥18yrs: One (6mg) dose SC to the lateral thigh or upper arm only. May repeat after 1hr; max two (6mg) doses in 24hrs.
<18yrs: Not recommended.
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.
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
10/
 
60mg,
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.
PROPHYLAXIS
Calcitonin Gene-Related Peptide (CGRP) Receptor Antagonist
erenumab-aooe 70mg/mL Aimovig Rx soln for SC inj Adults: 70mg SC once monthly; some patients may benefit from 140mg (two 70mg inj) 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 120mg/mL Emgality Rx soln for SC inj Adults: Initially 240mg SC loading dose (two 120mg inj), followed by 120mg monthly.
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. 11/2018)