So far, we don't have medications to attack substance P directly. Knowledge of a patient's migraine history is essential for determining which medication to prescribe. Patients with little warning need something that works quickly. Medication choices include Imitrex, which comes in injectable, nasal and pill forms, a nasal spray Migranal, and oral medications Zomig and Amerge. Two more pills are awaiting FDA approval.
Reaction times vary with injections being the quickest.
Since most people are accustomed to taking pills, drug companies are hoping to find a pill that will work in 30 minutes for most patients. A combined treatment of nasal spray and pill, which is being tested at Baylor, also should prove effective. Derman cautions that people with high blood pressure and coronary artery disease should not use these medications.