Other acute migraine treatments

Ergot alkaloids

Ergot alkaloids such as ergotamine and dihydroergotamine have been used in clinical practice for the acute treatment of migraine for at least 50 years. Their mechanism of action is complex and is thought to involve the interaction of a variety of receptors, including 5-HT receptors (particularly 5-HT_1B/1D and 5-HT₂) and dopamine D2 receptors. Ergotamine is widely used in some countries for the treatment of severe migraine attacks. However, many headache experts consider that a triptan is generally better than ergotamine in terms of efficacy and safety in the majority of migraineurs who require a specific anti-migraine medication.^[1] The use of ergotamine may be associated with side effects such as nausea and vomiting, abdominal discomfort, acroparaesthesia and leg cramps.

Methysergide is an ergotamine derivative used in the preventative treatment of migraine.  More information on methysergide is included in the Preventative Migraine Treatments section.

Over-the-counter migraine treatments

Unlike migraine-specific treatments such as the triptans, OTC medications act on peripheral pain receptors and do not act on the underlying cause of migraine. Despite this, almost all (95%) migraine sufferers have taken an OTC medication at some stage to help manage their condition.^[2] For this reason, it is important that physicians ascertain which, if any, OTC medications their patients are using, and ensure that these medications are managed appropriately as part of a management strategy.

Over-the-counter (OTC) medications such as simple analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) may provide relief in patients with mild migraine. Simple analgesics (e.g. aspirin, paracetamol/acetaminophen) and NSAIDs (e.g. naproxen or ibuprofen) may effectively treat attacks of mild intensity.

Caffeine is often added to an analgesic to facilitate its absorption, thereby increasing its effectiveness. These agents may be used alone or in combination for improved efficacy (i.e. the combination of paracetamol/acetaminophen, aspirin and caffeine).

Overuse of OTC therapies can lead to medication-overuse headache. Choosing an effective treatment that is matched to the individual needs of each patient may avoid the overuse of ineffective medications.

1. Tfelt-Hansen P, Saxena PR, Dahlof C, Pascual J, Lainez M, Henry P, et al. Ergotamine in the acute treatment of migraine: a review and European consensus. Brain 2000;123 (Pt 1): 9-18.
2. MacGregor EA, Brandes J, Gendolla A, Giammarco R. Migraine treatment strategies: the global Migraine And Zolmitriptan Evaluation (MAZE) survey--phase IV. Curr Med Res Opin 2004;20: 1777-83.