Authors
Chi Ieong Lau, Wei-Ta Chen, Tsung-Wei Hou, Yi-Chia Liaw, Yi-Hsien Tu, Jr-Wei Wu, Chun-Pai Yang, Ping-Kun Chen, Shih-Pin Chen, Wei-Hung Chen, Yen-Yu Chen, Jong-Ling Fuh, Yung-Chu Hsu, Tzu-Chou Huang, Tzu-Hsien Lai, Jen-Feng Liang, Kang-Hsu Lin, Kao-Chang Lin, Ching-Sen Shih, Shuu-Jiun Wang, Chun Ming Yang, Fu-Chi Yang, Tu-Hsueh Yeh, Yen-Feng Wang
Published in
Journal of the Chinese Medical Association : JCMA. Sep 11, 2026. Epub Sep 11, 2026.
Abstract
Since the publication of the Taiwan Headache Society's 2022 Guidelines for the Acute Treatment of Migraine Attacks, advances in headache medicine and the approval of new drugs in Taiwan have necessitated an update. To address clinical needs, the Guideline Committee of the Taiwan Headache Society reviewed evidence for pharmacological and non-pharmacological acute treatments using evidence-based principles. Drawing from the latest European, American, and international guidelines, and through expert consensus, this revision updates treatment roles, grades of recommendation, efficacy, and adverse-effect profiles. Currently, a broad range of medications is available in Taiwan for acute migraine management, categorised into "specific" and "non-specific" agents. Specific treatments include oral and intranasal triptans, and gepants, i.e., oral calcitonin gene-related peptide (CGRP) receptor antagonists. Non-specific agents include acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs: diclofenac, ibuprofen, naproxen). Injectable prochlorperazine is also strongly recommended. Ergotamine/caffeine combinations are less effective and are second-line agents, while high-dose aspirin is limited by gastrointestinal risk. Considering the potential risk of dependency, tramadol or tramadol/paracetamol combinations should be reserved until all other agents fail, and should be limited to oral forms. Other opioids, such as morphine, butorphanol, etc., lack evidence and are not recommended. Treatment should follow the principle of stratified care: oral NSAIDs for mild disability, with combination analgesics or parenteral NSAIDs as alternatives, and oral or intranasal triptans for moderate to severe disability, ideally administered early. Antiemetics may be added, and combining triptans with NSAIDs enhances efficacy. Rimegepant can be considered a first-line therapy, particularly for patients who are unresponsive or intolerant to triptans, have cardiovascular contraindications, or are at risk of developing medication overuse. In status migrainosus, parenteral corticosteroids with intravenous fluids are advised. Acetaminophen remains first-line for children and pregnant women. To prevent medication-overuse headache, acute treatments, including NSAIDs, acetaminophen, triptans, ergot derivatives, and combination analgesics, should not exceed two days per week, probably with the exception of rimegepant.
PMID:
42723131
Bibliographic data and abstract were imported from PubMed on 11 Sep 2026.
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