title: Canadian Headache Society Guideline: acute drug therapy for migraine headache.
abstract: OBJECTIVE
  The primary objective of this guideline is to assist the practitioner in choosing an appropriate acute medication for an individual with migraine, based on current evidence in the medical literature and expert consensus. It is focused on patients with episodic migraine ( headache on ≤ 14 days a month).
  
  
  METHODS
  A detailed search strategy was used to find a relevant meta-analyses, systematic reviews and randomized double-blind controlled trials. Recommendations were graded with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group, using a consensus group. In addition, a general literature review and expert consensus were used for aspects of acute therapy for which randomized controlled trials were not available.
  
  
  RESULTS
  Twelve acute medications received a strong recommendation for use in acute migraine therapy (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zomitriptan, ASA, ibuprofen, naproxen sodium, diclofenac potassium, and acetaminophen). Four received a weak recommendation for use (dihydroergotamine, ergotamine, codeine-containing combination analgesics, and tramadol- containing medications). Three of these were NOT recommended for routine use (ergotamine and codeine- and tramadol- containing medications). Strong recommendations were made to avoid use of butorphanol and butalbital- containing medications. Metoclopramide and domperidone were strongly recommended for use when necessary. Our analysis also resulted in the formulation of eight general acute migraine management strategies. These were grouped into: 1) two mild-moderate attack strategies, 2) two moderate-severe attack or NSAID failure strategies, 3) three refractory migraine strategies, and 4) a vasoconstrictor unresponsive-contraindicated strategy. Additional were developed for menstrual migraine during pregnancy, and migraine during lactation.
  
  
  CONCLUSIONS
  This guideline provides evidence-based advice on acute pharmacological migraine therapy, and should be helpful to both health professionals and patients, The available medications have been organized into a series of strategies based on patient clinical features. These strategies may help practitioners make appropriate acute medication choices for patients with migraine.
authors: Sunnybrook Health Sciences Centre, Toronto, Ontario.
authors: Irene
authors: I
authors: Worthington
authors: Tamara
authors: T
authors: Pringsheim
authors: Marek J
authors: MJ
authors: Gawel
authors: Jonathan
authors: J
authors: Gladstone
authors: Paul
authors: P
authors: Cooper
authors: Esma
authors: E
authors: Dilli
authors: Michel
authors: M
authors: Aube
authors: Elizabeth
authors: E
authors: Leroux
authors: Werner J
authors: WJ
authors: Becker
mesh_terms: D000208:Acute Disease; D005260:Female; D006801:Humans; D008499:Medical Records; D008881:Migraine Disorders / Q000188:drug therapy*; D010361:Patients; D058007:Physicians, Primary Care; D011247:Pregnancy