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Although narcotics remain the most frequently administered medication for patients with migraine and for ED patients with headache, evidence suggests that they are potentially ineffective, and their use may lead to more prolonged ED stays.

Friedman et al found that nearly three quarters of ED patients with migraine or other primary headache reported headache recurrence within 48 hours of ED discharge; in this study, naproxen 500 mg and oral sumatriptan 100 mg provided comparable relief of post-ED recurrent migraine.

If an oral contraceptive is suspected to be a trigger, the patient may be advised to modify, change, or discontinue its use for a trial period.

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Patients with frequent attacks usually require both.

Measures directed toward reducing migraine triggers are also generally advisable.

Acute treatment aims to reverse, or at least stop, the progression of a headache that has started.

Preventive treatment, which is given even in the absence of a headache, aims to reduce the frequency and severity of the migraine attack, make acute attacks more responsive to abortive therapy, and perhaps also improve the patient's quality of life.

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