Analgesics and NSAIDs in the treatment of the acute migraine attack

In the treatment of migraine attacks, an antiemetic in combination with an analgesic or ergot alkaloid is widely recommended. Medication should be introduced as early as possible, but only when there is no doubt that the headache is due to migraine. The antiemetic provides relief from the nausea and vomiting and also enhances the resorption of analgesics or ergot preparations. Domperidone 20 mg orally and 20 mg metoclopramide as suppository or 10–20 mg orally are mostly used as antiemetics. Analgesics such as 1000 mg acetylsalicylic acid as effervescent tablets, or 1000 mg paracetamol as effervescent tablets or suppositories should be given 15–20 min later. If this treatment fails, NSAIDs can be tried. In some studies naproxen in doses between 500 and 1000 mg and ibuprofen in doses between 400 and 800 mg have been shown to be effective, as well as NSAIDs like diclofenac, mefenamic acid, ketoprofen, tolfenamic acid and pirprofen. NSAIDs have been found to be superior to placebo and to standard reference drugs in the majority of the reviewed double-blind trials. Nevertheless, these effects are marginal in some studies or even without clinical relevance. Accordingly, there is still a need for further comparative studies.