Therapy		Dosing	Cost of generic (brand)*	Major adverse effects	Comments
First-line therapies
Combination analgesics
	Acetaminophen, 250 mg/aspirin, 250 mg/caffeine, 65 mg (Excedrin Migraine)	1 or 2 tablets (or capsules) every 6 hours, not to exceed 8 tablets per day	Varies	See individual medications	Available without a prescription
NSAIDs
	Ibuprofen	200 to 800 mg orally every 6 to 8 hours, not to exceed 2.4 g per day	Varies	Heartburn, gastric bleeding, ulcers, rebound headache, renal toxicity; can exacerbate heart failure and hypertension	Available without a prescription; many patients have already tried nonprescription NSAIDs before seeking medical advice Cannot be used in the third trimester of pregnancy Generally well-tolerated
	Naproxen	250 to 500 mg orally every 12 hours, not to exceed 1 g per day	Varies
	Naproxen		Varies
Triptans
	Almotriptan (Axert)	6.25 to 12.5 mg orally, can be repeated in 2 hours, not to exceed 25 mg per day	NA ($154) for 12 tablets	Hypertension, vasospasm, chest pain, malaise, fatigue, rebound headache	Should be avoided in patients with a history of myocardial infarction, cerebrovascular accident, Prinzmetal angina, uncontrolled hypertension, or other vascular diseases, and in pregnant women Do not use with monoamine oxidase inhibitors Case reports of serotonin syndrome when combined with selective serotonin reuptake inhibitors
	Eletriptan (Relpax)	20 to 40 mg orally, can be repeated in > 2 hours, not to exceed 80 mg per day	NA ($155) for 6 tablets
	Frovatriptan (Frova)	2.5 mg orally, can be repeated in 2 hours, not to exceed 7.5 mg per day	NA ($242) for 9 tablets
	Naratriptan (Amerge)	1 to 2.5 mg orally, can be repeated in 2 hours, not to exceed 5 mg per day	NA ($276) for 9 tablets
	Rizatriptan (Maxalt)	5 to 10 mg orally, can be repeated in 2 hours, not to exceed 30 mg per day	NA ($287) for 3 tablets
	Sumatriptan (Imitrex)	Intranasal: 5 to 20 mg, can be repeated in 2 hours, not to exceed 40 mg per day	Intranasal: $39† ($55)
		Oral: 25 to 100 mg, can be repeated in 2 hours, not to exceed 200 mg per day	Oral: $620 ($792) for 27 tablets
			Oral: $620 ($792) for 27 tablets
		Subcutaneous: 4 to 6 mg, may repeat in 1 hour, not to exceed 12 mg per day	Subcutaneous: $184 for 2 vials ($445 for 5 vials)
	Zolmitriptan (Zomig, Zomig-ZMT‡)	Intranasal: 5 mg, may repeat in 2 hours, not to exceed 10 mg per day	Intranasal: NA ($38)
		Oral disintegrating tablets: 2.5 mg, can be repeated in 2 hours, not to exceed 10 mg per day	Oral disintegrating tablets: NA ($154) for 6 tablets
		Oral: 1.25 to 2.5 mg, can be repeated in 2 hours, not to exceed 10 mg per day	Oral: NA ($156) for 6 tablets (2.5 mg)
Combination triptans and NSAIDs
	Sumatriptan, 85 mg/naproxen, 500 mg (Trexima)	1 tablet at onset, may repeat in 2 hours, not to exceed 2 tablets per day	NA ($206 for 9 tablets)	See individual medications	—
Other effective therapies
Antiemetics
	Metoclopramide (Reglan)	10 mg IV every 8 hours	$1† ($2†) for 5-mg vial	Dystonic reaction; parkinsonism with metoclopramide use	—
	Prochlorperazine	10 mg IV every 8 hours, not to exceed 40 mg per day	$3† for 5-mg vial	Dystonic reaction; parkinsonism with metoclopramide use	—
Dexamethasone [ corrected]		10 to 25 mg IV, one-time dose	$42 for 25 vials (4 mg)	Hyperglycemia, mood changes, insomnia; multiple adverse effects with long-term use	Use as adjunctive therapy only
Ergotamines
	Dihydroergotamine (DHE; Migranal§)	Intranasal: 1 spray in each nostril, repeat once after 15 minutes; not to exceed 4 sprays per attack, 6 sprays per day, 8 sprays per week	Intranasal: NA ($100)	Nausea; rhinorrhea with intranasal use; similar adverse effects as triptans	IV dosing can be used in combination with 10 mg metoclopramide every 8 hours as needed for nausea
		IV: 0.5 to 1 mg repeated every 8 hours, or continuous IV infusion totaling 3 mg per 24 hours; not to exceed 3 mg per attack	IV: $32 ($124)
		Subcutaneous: 1 mg every hour; not to exceed 3 mg per day	Subcutaneous: $32
Isometheptene compounds
	Acetaminophen, 325 mg/dichloralphenazone, 100 mg/isometheptene, 65 mg (Midrin)	1 to 2 capsules orally every 4 hours; not to exceed 8 capsules per day	$43 ($22†) for 30 capsules	–	Use caution in patients with cardiovascular risk factors
Lidocaine (Xylocaine)		Intranasal: 0.5 mL of topical lidocaine 4% solution dripped into the nostril on the affected side over 30 seconds; administered by a clinician while patient lies in the supine position with head hyperextended and tilted to 30 degrees	NA ($22†) for 50 mL	Rare cardiac adverse effects if systemically absorbed	Not all patients will benefit, and symptoms may recur