Semin Neurol 2010; 30(2): 145-153
DOI: 10.1055/s-0030-1249223
© Thieme Medical Publishers

Acute Treatment of Migraine Headaches

Frederick R. Taylor1 , 2
  • 1Headache Clinic and Research Center, Park Nicollet Health Services, Minneapolis, Minnesota
  • 2University of Minnesota School of Medicine, Minneapolis, Minnesota
Further Information

Publication History

Publication Date:
29 March 2010 (online)


Optimum acute treatment of migraine requires prevention of headache as a top priority. Recognition of the multitude of migraine presentations, the frequency of total headache attacks, and number of days of headache disability are critical. Successful treatment requires excellent patient–clinician communication enhancing confidence and mutual trust based on patient needs and preferences. Optimum management of acute migraine nearly always requires pharmacologic treatment for rapid resolution. Migraine-specific triptans, dihydroergotamine, and several antiinflammatories have substantial empirical clinical efficacy. Older nonspecific drugs, particularly butalbital and opioids, contribute to medication overuse headache and are to be avoided. Clinicians should utilize evidence-based acute migraine-specific therapy stressing the imperative acute treatment goal of early intervention, but not too often with the correct drug, formulation, and dose. This therapy needs to provide cost-effective fast results, meaningful to the patient while minimizing the need for additional drugs. Migraine-ACT evaluates 2-hour pain freedom with return to normal function, comfort with treatment, and consistency of response. Employ a thoroughly educated patient, formulary, testimonials, stratification, and rational cotherapy against the race to central sensitization for optimum outcomes.


Frederick R Taylor, M.D. 

Director, Headache Clinic and Research Center, Park Nicollet Health Services

6490 Excelsior Boulevard Minneapolis, MN 55426