HeadWise Understanding Acute Migraine Treatments: What’s Available and How They Work
Oct 15, 2025
Dr. Robert Kaniecki, a board-certified neurologist and director of the UPMC Headache Center, shares his expertise on acute migraine treatments. He delves into over-the-counter pain relievers and prescription NSAIDs, provided guidance on choosing triptans, and discusses newer options like gepants and modern DHE delivery systems. Listeners also learn about effective combination medications and non-drug strategies that aid recovery. This engaging conversation offers valuable insights for anyone looking to tackle migraine attacks.
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Begin With Full-Dose OTC NSAIDs
- Start acute migraine treatment with a full-dose OTC NSAID like naproxen or ibuprofen for moderate to severe attacks.
- Use a full dose, not a half dose, to maximize benefit as recommended in guidelines.
Use Higher-Dose Prescription NSAIDs
- Consider prescription-strength NSAIDs (eg, ibuprofen 800 mg or naproxen 500–550 mg) when OTC doses are inadequate.
- Higher-dose aspirin (900–975 mg) can be effective as a single acute dose in some patients.
Sumatriptan Injection Is Still A Gold Standard
- Sumatriptan injection remains the benchmark for rapid, powerful migraine relief and nothing has proven superior since it launched.
- Injection avoids vomiting and suits wake-up migraines that are already severe on onset.