Migraine headache: options for acute treatment

The optimal acute treatment of migraine requires recognition of the multitude of migraine presentations, the frequency of total attacks, and number of days of headache disability. These initial diagnostic steps are initiated in the waiting room, but phase-specific and stratified treatment selection requires having mutual understanding, trust, and belief through extensive discussion. The imperative acute treatment goal must be to treat early, but not too often, a fact represented by a 75% or better occurrence of pain freedom at 2 hours with two or fewer drug doses averaging 2 or fewer days a week. Migraine-specific therapy best wins the race against time and allodynia. Employing this formulary, multiple triptan formulations and phase and stratified patient-centered therapy creates success.