Unmet needs in the acute treatment of migraine

What are the acute treatment options for migraine if current medications are not effective, are overused, are not tolerated, or are contraindicated? Or if the patient is a child, pregnant, breastfeeding, or elderly? The limited options available, reflecting unmet needs in the management of acute migraine, were highlighted by experts at a symposium at EAN 2020.

Pain points in the acute treatment of migraine

Only 25–35% of patients are pain-free 2 hours after treatment with triptans or NSAIDs

Triptans have become increasingly popular for the acute treatment of migraine, though non-steroidal anti-inflammatory drugs (NSAIDs) are often used as an initial strategy for aborting migraine attacks,1 said Christian Lampl of Linz, Austria.

However, a network meta-analysis comparing the relative efficacy and tolerability of NSAIDs and triptans revealed that the median proportion of patients who are pain-free 2 hours after treatment—which is the primary measure of efficacy recommended by the International Headache Society2—ranged from only 25–35%.1

Frequent use of acute medications can lead to medication overuse headache

For many patients triptans are not adequately effective or lose efficacy over time, have intolerable adverse effects, or are contraindicated, for example due to concomitant cardiovascular disease, said Dr Lampl.3

New therapeutic options are needed, he said, and this is highlighted by the persistent use of medications such as barbiturates and opioids, which have the potential for misuse, and the occurrence of medication overuse headaches due to excessive use of acute treatments.4


Limited therapeutic options for special populations

Limited treatment options for children, pregnant women and the elderly

Challenges in the acute management of migraine also arise when treating certain populations of patients, and reflect further unmet needs, said Aynur Özge of Mersin, Turkey. These populations include:

  • children, for whom there are limited available and licensed medications for the treatment of migraine5
  • pregnant and breastfeeding women, for whom treatment should not be postponed because undermanaged headache can lead to stress, sleep deprivation, depression and poor nutritional intake—but nonpharmacological interventions should be tried first before deciding upon medication based on the benefit–risk balance6
  • the elderly, for whom treatment choice needs to take account all comorbidities7

Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.


  1. Xu et al J Headache Pain 2016;17:113.
  2. Diener H-C, et al. Cephalalgia 2019;39:687–710.
  3. Do J Headache Pain 2019;20:37.
  4. Diener H-C, et al. Nat Rev Neurol 2016;12:575–83.
  5. Abu-Arafeh I. Progr Neurol Psych 2014;18:16–20.
  6. Negro A, et al. J Headache Pain 2017;18:106. doi: 10.1186/s10194-017-0816-0
  7. Haan J, et al. Cephalalgia 2007;27:97–106.