All sections

Section 02

Migraine & Headache

Acute & Preventive Therapies

46 AGENTS

Sumatriptan

ImitrexTriptan
Forms
Tab: 25, 50, 100mg | SC: 4, 6mg | NS: 5, 20mg
Dose
50-100mg PRN (max 200mg/day)
MOA
5-HT1B/1D agonist; cranial vasoconstriction
Full monograph

Rizatriptan

MaxaltTriptan
Forms
Tab: 5, 10mg | ODT: 5, 10mg
Dose
5-10mg PRN (max 30mg/day)
MOA
5-HT1B/1D agonist
Full monograph

Zolmitriptan

ZomigTriptan
Forms
Tab: 2.5, 5mg | ODT: 2.5, 5mg | NS: 2.5, 5mg
Dose
2.5-5mg PRN (max 10mg/day)
MOA
5-HT1B/1D agonist
Full monograph

Eletriptan

RelpaxTriptan
Forms
Tab: 20, 40mg
Dose
20-40mg PRN (max 80mg/day)
MOA
5-HT1B/1D agonist
Full monograph

Naratriptan

AmergeTriptan
Forms
Tab: 1, 2.5mg
Dose
1-2.5mg PRN (max 5mg/day)
MOA
5-HT1B/1D agonist
Full monograph

Frovatriptan

FrovaTriptan
Forms
Tab: 2.5mg
Dose
2.5mg PRN (max 7.5mg/day)
MOA
5-HT1B/1D agonist
Full monograph

Almotriptan

AxertTriptan
Forms
Tab: 6.25, 12.5mg
Dose
12.5mg PRN (max 25mg/day)
MOA
5-HT1B/1D agonist
Full monograph

Dihydroergotamine

Migranal / TrudhesaErgot alkaloid
Forms
NS: Migranal 4mg/mL, Trudhesa 0.725mg/spray | IM/IV/SC: 1mg/mL
Dose
1 spray/nostril, may repeat x1
MOA
5-HT1/adrenergic/dopamine agonism
Full monograph

Ergotamine-caffeine

CafergotErgot alkaloid
Forms
Tab: 1mg/100mg caffeine
Dose
1-2mg PRN (max 6mg/day)
MOA
5-HT1 receptor agonism
Full monograph

Ubrogepant

UbrelvyGepant · oral
Forms
Tab: 50, 100mg
Dose
50-100mg PRN (max 200mg/day)
MOA
CGRP receptor antagonist
Full monograph

Rimegepant

Nurtec ODTGepant · oral
Forms
ODT: 75mg
Dose
75mg PRN or QOD prevention
MOA
CGRP receptor antagonist
Full monograph

Zavegepant

ZavzpretGepant · intranasal
Forms
NS: 10mg/spray
Dose
10mg intranasal PRN
MOA
CGRP receptor antagonist
Full monograph

Lasmiditan

ReyvowDitan
Forms
Tab: 50, 100, 200mg
Dose
50-200mg PRN (avoid driving 8h)
MOA
Selective 5-HT1F agonist (non-vasoconstrictive)
Full monograph

Atogepant

QuliptaGepant · oral
Forms
Tab: 10, 30, 60mg
Dose
10-60mg once daily
MOA
CGRP receptor antagonist
Full monograph

Erenumab

AimovigCGRP mAb · injectable
Forms
SC autoinjector: 70, 140mg
Dose
70-140mg SC monthly
MOA
Blocks CGRP receptor
Full monograph

Fremanezumab

AjovyCGRP mAb · injectable
Forms
SC syringe: 225mg/1.5mL
Dose
225mg mo. or 675mg quarterly
MOA
Binds CGRP ligand
Full monograph

Galcanezumab

EmgalityCGRP mAb · injectable
Forms
SC autoinjector: 120mg/mL
Dose
240mg load, then 120mg/mo
MOA
Binds CGRP ligand
Full monograph

Eptinezumab

VyeptiCGRP mAb · IV infusion
Forms
IV: 100mg/mL vial
Dose
100-300mg IV every 3 months
MOA
Binds CGRP ligand
Full monograph

Propranolol

InderalBeta-blocker
Forms
Tab: 10, 20, 40, 60, 80mg | LA: 60, 80, 120, 160mg
Dose
80-240mg/day (prevention)
MOA
Nonselective β1/β2 blockade
Full monograph

Metoprolol

LopressorBeta-blocker
Forms
Tab: 25, 50, 100mg | ER: 25-200mg
Dose
50-200mg/day (prevention)
MOA
Selective β1 blockade
Full monograph

Topiramate

TopamaxAED (migraine prevention)
Forms
25-100mg
Dose
Start 25mg qHS, titrate weekly to 50-100mg/day (prevention)
MOA
Na+ blockade, ↑GABA
Full monograph

Valproate

DepakoteAED (migraine prevention)
Forms
DR tab: 125, 250, 500mg
Dose
500-1000mg/day (prevention)
MOA
↑GABA, Na+/Ca2+ blockade
Full monograph

Amitriptyline

ElavilTCA
Forms
Tab: 10, 25, 50, 75, 100, 150mg
Dose
10-75mg qHS (prevention)
MOA
Serotonin/NE reuptake inhibition
Full monograph

Venlafaxine

Effexor XRSNRI
Forms
ER cap: 37.5, 75, 150, 225mg
Dose
75-150mg/day (prevention)
MOA
Serotonin/NE reuptake inhibition
Full monograph

Candesartan

AtacandARB
Forms
Tab: 4, 8, 16, 32mg
Dose
16-32mg/day (prevention)
MOA
Angiotensin II receptor blockade
Full monograph

Metoclopramide

ReglanDopamine antagonist
Forms
Tab: 5, 10mg | IV/IM: 5mg/mL
Dose
10mg TID PRN (adjunct/nausea)
MOA
D2 blockade, prokinetic
Full monograph

Prochlorperazine

CompazineDopamine antagonist
Forms
Tab: 5, 10mg | Supp: 25mg | IV/IM: 5mg/mL
Dose
5-10mg TID-QID PRN
MOA
D2 receptor blockade
Full monograph

OnabotulinumtoxinA

BotoxNeurotoxin · injectable
Forms
155-195 units, 31 injection sites
Dose
q12 weeks, chronic migraine
MOA
Blocks presynaptic ACh release
Full monograph

Sumatriptan-naproxen

TreximetTriptan + NSAID
Forms
Tab: 85/500mg
Dose
1 tab PRN, may repeat after 2h (max 2 tabs/day)
MOA
5-HT1B/1D agonism + COX inhibition
Full monograph

Diclofenac potassium

CambiaNSAID
Forms
Powder packet: 50mg
Dose
50mg once at onset (mix in water)
MOA
COX inhibition
Full monograph

Celecoxib oral solution

ElyxybNSAID (COX-2)
Forms
Sol: 120mg/4.8mL
Dose
120mg once at onset (max 120mg/day)
MOA
Selective COX-2 inhibition
Full monograph

Ibuprofen

Motrin / AdvilNSAID
Forms
Tab: 200, 400, 600, 800mg | Susp: 100mg/5mL
Dose
400-800mg PRN (max 3200mg/day Rx; 1200mg/day OTC)
MOA
COX inhibition
Full monograph

Naproxen sodium

Anaprox DS / AleveNSAID
Forms
Tab: 220mg (OTC), 275, 550mg
Dose
550mg at onset (max 1375mg/day)
MOA
COX inhibition
Full monograph

Aspirin-acetaminophen-caffeine

Excedrin MigraineAnalgesic combination
Forms
Tab: 250/250/65mg
Dose
2 tabs once; max 2 tabs/24h (OTC)
MOA
COX inhibition + central analgesia; caffeine adjunct
Full monograph

Indomethacin

IndocinNSAID
Forms
Cap: 25, 50mg | ER cap: 75mg | Supp: 50mg | Susp: 25mg/5mL
Dose
Start 25mg TID, titrate to response (indomethacin-responsive headaches: paroxysmal hemicrania, hemicrania continua)
MOA
COX inhibition
Full monograph

Verapamil

Calan / IsoptinCalcium channel blocker
Forms
IR tab: 40, 80, 120mg | SR tab: 120, 180, 240mg | ER cap: 100-360mg
Dose
Cluster prevention: 240-480mg/day divided (ECG monitoring with dose increases)
MOA
L-type Ca2+ channel blockade
Full monograph

Lithium

Lithobid / genericMood stabilizer
Forms
Cap: 150, 300, 600mg | ER tab: 300, 450mg
Dose
Cluster prevention (off-label): 600-900mg/day; target level 0.4-0.8 mEq/L
MOA
Mechanism unclear; modulates second-messenger signaling
Full monograph

Magnesium

supplementMineral supplement
Forms
Tab/Cap: 250-500mg elemental
Dose
400-600mg/day elemental (prevention)
MOA
NMDA modulation; ↓cortical spreading depression
Full monograph

Riboflavin (vitamin B2)

supplementVitamin supplement
Forms
Tab/Cap: 100, 400mg
Dose
400mg once daily (prevention)
MOA
Supports mitochondrial energy metabolism
Full monograph

Acetazolamide

DiamoxCarbonic anhydrase inhibitor
Forms
Tab: 125, 250mg | ER cap: 500mg | IV: 500mg vial
Dose
IIH: 1-4g/day divided | Episodic ataxia: 250-1000mg/day
MOA
↓CSF production; metabolic acidosis
Full monograph

Ketorolac

Toradol / SprixNSAID · parenteral
Forms
Inj: 15, 30mg/mL | Tab: 10mg | NS: 15.75mg/spray (Sprix)
Dose
IV/IM 15-30mg single dose (ED migraine); max 5 days total therapy | Sprix: 31.5mg (one spray each nostril) q6-8h, max 126mg/day
MOA
Potent COX inhibition
Full monograph

Chlorpromazine

ThorazinePhenothiazine antipsychotic
Forms
Tab: 10, 25, 50, 100, 200mg | IV/IM: 25mg/mL
Dose
Acute migraine (off-label): 12.5mg IV every 15 min up to 37.5mg, or 25-50mg IM; usually with IV fluids
MOA
D2, H1, α1 and muscarinic blockade
Full monograph

Droperidol

InapsineButyrophenone antiemetic
Forms
IV/IM: 2.5mg/mL
Dose
Acute migraine/nausea (off-label): 1.25-2.5mg IV with ECG monitoring
MOA
D2 blockade at the chemoreceptor trigger zone
Full monograph

Nadolol

CorgardBeta-blocker
Forms
Tab: 20, 40, 80mg
Dose
Migraine prevention (off-label): start 20-40mg daily, titrate to 80-240mg/day
MOA
Nonselective β1/β2 blockade
Full monograph

Timolol

Blocadren / genericBeta-blocker
Forms
Tab: 5, 10, 20mg
Dose
Migraine prevention: 10mg BID (max 30mg/day)
MOA
Nonselective β1/β2 blockade
Full monograph

Cyproheptadine

PeriactinH1/5-HT2 antagonist
Forms
Tab: 4mg | Syrup: 2mg/5mL
Dose
Migraine prevention (off-label): pediatric 0.25-0.5mg/kg/day divided; adults 4-12mg/day
MOA
Antihistamine with serotonin 5-HT2 antagonism
Full monograph