Initial Abortive Treatments for Migraine Headache.

Stratify care by choosing the optimal medication for a migraine. Severe pain, significant disability, and associated features such as nausea or vomiting necessitate early treatment with specific, high efficacy therapy. Migraine patients may have a spectrum of headache presentations ranging from tension-type headaches to migraine headaches with or without aura. Mild headache types may respond to simple analgesics, though there is evidence that migraineurs will respond to migraine-specific medications such as the triptans for a range of headache phenotypes. Physicians should provide patients with medication to treat nausea and vomiting. They may be infrequent accompaniments, but medication such as a neuroleptic may avoid a trip to the emergency room. Provide rescue medication for an occasional failure of usual treatment to avoid further disability or emergency room visits. Avoid medication overuse by matching treatment to patient needs. A cycle of repetitive and escalating medication use can lead to transformation of migraine into chronic daily headache with analgesic-dependent rebound.