Patients who suffer the misery of migraine headaches are given a special designation that sufferers of other diseases do not warrant. That designation is Migraineur. So people who have severe, one-sided, pounding, throbbing, and debilitating headaches associated with sensitivity to light and sound, and nausea are migraineurs. Migraines can occur frequently or maybe only once a month, but there is a wide variation.
One thing all migraineurs wish for is rapid and complete relief of the pain. Migraine headaches send patients to a dark, quiet room where they just want to be left alone. Depending on the efficacy of their treatment, migraines can last up to 12-24 hours, but most patients want immediate relief. Migraineurs will try anything to get relief.
Fortunately, there are effective medications that do provide the relief migraineurs so desperately seek. A recent article in American Family Physician briefly discusses options for pain relief. It is based on research done by the Cochrane Foundation and was published in the Annals of Internal Medicine. The conclusion of the analysis narrows effective treatment to Triptans and NSAID’s.
Triptans, which are available in oral, injectable, or nasal spray forms, were “the most effective for pain relief at 2 hours and freedom from pain for 48 hours after treatment.” Adding an NSAID to a Triptan provides better relief than the triptan alone. Acetaminophen added to a triptan does not improve pain relief. Treatment with a triptan may be associated with a higher risk for adverse effects. But these effects are not serious or life-threatening, and the patient whose headache has been quickly relieved will tolerate adverse effects without complaint.
NSAID’s may be effective, but don’t have the specificity of treatment of triptans. They can be initial therapy, but if relief is not obtained, a triptan should be given.
New Migraine Drugs do not have an advantage over standard NSAID and triptan drugs.
Dr. G’s Opinion: Triptans are the drugs of choice for migraine relief. I first used them in 1990 when sumatriptan, the first triptan, was available only as a subcutaneous injection. It was a miracle drug that relieved migraines in 45 minutes. And the headache stayed away. Having not been involved in clinical medicine for 11 years, I’m not up to date on newer triptans or what form is most effective. Oral forms work, but not as quickly as a subq injection. NSAID’s are worth a try, but they just don’t have the potency of a triptan. So if you know they give you lasting relief, why not use a triptan as first line treatment.
Reference: Shaughnessy AF. Comparative benefits of available Treatments for Acute Migraine Pain Am Fam Phys 2025 December;112(6):692.
