The route of administration is an important component of migraine therapy. Oral therapy is usually the first choice for most patients, and can be effective even if nausea and vomiting are associated with the migraine attack, provided that the oral route is initiated early in the migraine attack. Patients with severe vomiting may require non-oral treatment. The recent availability of an intranasal preparation of sumatriptan and DHE has expanded parenteral treatment options. For severe migraines, subcutaneous injections may be the most appropriate choice, followed by intranasal preparations or rectal suppositories.
Oral preparations have the slowest onset of action.
Consider an antiemetic agent only in patients whose nausea and vomiting are not relieved by specific migraine therapy Nausea and vomiting are common accompaniments of migraine headache and can be as disabling as the headache itself. In the instances where the patient continues to experience nausea and vomiting, an antiemetic agent can be prescribed. Nonpharmacologic approaches may be an important adjunct to migraine management. Biofeedback may be a useful approach in certain patients, such as children, pregnant women, and individuals in whom stress is a trigger. Finally, physicians should ask about alternative medicines patients may be using simultaneously with traditional drug therapy.