| Drug | Class | Adult | Paediatric | Notes |
|---|---|---|---|---|
| Sumatriptan or rizatriptan (acute migraine)[1] | Triptan / 5-HT1B/1D agonist | Sumatriptan 50–100 mg PO at headache onset; nasal 10–20 mg; SC 6 mg for severe attacks. Rizatriptan 10 mg PO; up to 2 doses per attack | Adolescents ≥12: sumatriptan nasal 10 mg or rizatriptan ODT 5–10 mg | Most effective for moderate-severe migraine; combine with paracetamol or NSAID; max 9 days/month to prevent medication-overuse headache; contraindicated in CAD, uncontrolled HTN, hemiplegic migraine |
| Naproxen or ibuprofen (acute migraine and tension-type)[1] | NSAID | Naproxen 500 mg PO at onset, may repeat 250 mg in 6–8 h; ibuprofen 400–600 mg PO at onset | Ibuprofen 7–10 mg/kg/dose | First-line in mild–moderate attack; combine with antiemetic for nausea; max 14 days/month to avoid medication-overuse |
| Paracetamol (acute migraine and tension-type)[1] | Analgesic / antipyretic | 1 g PO at onset, max 4 g/day | 15 mg/kg/dose, max 60 mg/kg/day | Widely available alternative or combination with NSAID; max 14 days/month |
| Metoclopramide or prochlorperazine (acute nausea)[1] | Antiemetic | Metoclopramide 10 mg PO/IV/IM at onset; prochlorperazine 5–10 mg PO or 12.5 mg IM | Cyclizine if metoclopramide contraindicated (extrapyramidal risk) | Adjunct to triptan or NSAID; monitor extrapyramidal effects in young women |
| Sumatriptan SC + high-flow oxygen (acute cluster headache)[1] | Triptan + oxygen therapy | Sumatriptan 6 mg SC at onset, may repeat once after 1 h; 100% O2 12–15 L/min via non-rebreather × 15 min | — | First-line for cluster headache; tachycardia and chest tightness common; avoid in cardiovascular disease |
| Verapamil (cluster prophylaxis)[1] | Calcium channel blocker | 240–960 mg/day in divided doses; baseline ECG and PR interval monitoring | — | First-line preventive for episodic and chronic cluster headache; specialist initiation; bridge with steroid or galcanezumab during titration |
| Amitriptyline (chronic tension-type headache)[1] | Tricyclic antidepressant | 10–25 mg PO at night; titrate to 75 mg as tolerated | — | First-line preventive for frequent tension-type headache; first-line for migraine in those with comorbid depression or insomnia |
Diagnosis and acute management of migraine, tension-type headache, cluster headache, and medication-overuse headache in adults and adolescents ≥12 years.