Several medications were recently deemed the most effective for treating acute migraine, including triptans, dihydroergotamine (DHE), nonsteroidal anti-inflammatory drugs (NSAIDS), butorphanol nasal spray, and the combination medication of sumatriptan/naproxen and acetaminophen/aspirin/caffein). Several other migraine medications were considered “probably effective” or “possibly effective.”

The results of the study, a literature review spanning from 1998 to 2013, will serve as the basis for new American Headache Society (AHS) treatment guidelines. The original guidelines, published by the American Academy of Neurology (AAN) and the AHS 15 years ago, needed updating. This original review was undertaken by the National Headache Foundation.

“We hope that this assessment of the efficacy of currently available migraine therapies helps patients and their physicians utilize treatments that are the most appropriate for them,” said author Stephen D. Silberstein, MD, FACP, of the Jefferson Headache Center of Thomas Jefferson University, in a press release. “Several large, randomized acute pharmacological migraine treatment trials have been conducted since the release of the 2000 AAN/AHS guidelines, so it was important that we update our guidelines to reflect the latest evidence.”

The authors noted that doctors and other health care professionals must consider medication efficacy, potential side effects, and possible medication-related adverse events when prescribing acute medications for migraine. Although opioids such as butorphanol, codeine/acetaminophen and tramadol/acetaminophen are probably effective, they are not recommended for regular use.

“This report focusing on acute migraine treatment reflects the changing nature of guidelines toward evidence-based treatment rather than expert opinion,” said fellow author Michael J. Marmura, MD, also of the Jefferson Headache Center. “Large double-blind, placebo-controlled trials are the basis of determining the effectiveness of acute migraine treatment. Some clinical trials for headache performed prior to publication of the previous guidelines do not meet the more rigorous standards for clinical trials today.”

The article appeared last month in the journal Headache. In an accompanying editorial, Drs. Silberstein and Marmura noted that migraine sufferers are often dissatisfied with their treatment, and about half stop seeking care for their headaches. Meanwhile, migraine exacts a large toll on their personal lives and accounts for more than $13 billion dollars lost each year because of missed workdays.