PHILADELPHIA March 18, 2025 – The American College of Physicians (ACP) has developed new recommendations for treatment of acute episodic migraines in nonpregnant adults in outpatient settings. The new guideline, Pharmacologic Treatments for Acute Episodic Migraine Headache in Outpatient Settings: A Clinical Guideline from the American College of Physicians was published today in Annals of Internal Medicine.
Migraine is characterized by recurrent episodes of usually moderate to severe intensity headache lasting 4 to 72 hours with or without sensory disturbances, generally pulsating and often accompanied by nausea, vomiting, or aversion to light or sound. The condition remains underdiagnosed and undertreated.
ACP evaluated pharmacologic treatments known to be effective for migraine treatment using the best available comparative effectiveness evidence of benefits and harms, patients’ values and preferences, and economic evidence in order to prioritize the most effective treatments.
In its guideline, ACP makes two recommendations:
- ACP recommends that clinicians add a triptan to a nonsteroidal anti-inflammatory drug to treat moderate to severe acute episodic migraine headache in outpatient settings for nonpregnant adults who do not respond adequately to a nonsteroidal anti-inflammatory drug.
- ACP suggests that clinicians add a triptan to acetaminophen to treat moderate to severe acute episodic migraine headache in outpatient settings for nonpregnant adults who do not respond adequately to acetaminophen.
ACP also provides guidance to clinicians to consider counseling nonpregnant adults to begin treatment for acute migraine headache as soon as possible after its onset by utilizing combination therapy: a triptan with an NSAID or a triptan with acetaminophen.
ACP recently published a companion guideline, Prevention of Episodic Migraine Headache using Pharmacologic Treatments in Outpatient Settings, which addressed new recommendations for the prevention of episodic migraine in nonpregnant adults. In that guideline, ACP prioritized treatments based on economic and public and patient’s values and preferences evidence because the benefits and harms of evaluated treatments were balanced. However, for migraine treatment, ACP prioritized the combination of a triptan and an NSAID or acetaminophen because benefits outweighed the harms compared with other pharmacologic treatments.
“Migraine headaches remain underdiagnosed and undertreated,” said Isaac O. Opole, President, ACP. “While there are many pharmacologic options available to adults with migraine headache, this guideline will help clinicians assess the best course of treatment for this patient population, incorporating the best evidence and always with consideration of patients’ preferences, to make shared decisions for cost-effective treatment options that are best for the individual patient.”
ACP also recently published Incorporating Economic Evidence in Clinical Guidelines, which is a framework for standardizing the approach to identifying, appraising, and considering economic evidence in the development of ACP clinical guidelines, in recognition of accelerating health care costs and the impact on patients.
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About the American College of Physicians
The American College of Physicians is the largest medical specialty organization in the United States with members in more than 172 countries worldwide. ACP membership includes 161,000 internal medicine physicians, related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on X, Facebook, Instagram and LinkedIn.
Contact: Andrew Hachadorian, 215 351 2514, ahachadorian@acponline.org