Drugs for acute attack of migraine. I have taken naxdom 500 already

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Here is a structured overview of drugs for acute migraine, with context on Naxdom 500 (naproxen sodium 500 mg + domperidone), which you've already taken.

Drugs for Acute Migraine Attack

— Lippincott Illustrated Reviews: Pharmacology

What you've already taken: Naxdom 500

Naproxen sodium 500 mg + Domperidone 10 mg

Naproxen is an NSAID — a nonspecific analgesic that reduces migraine pain via prostaglandin inhibition
Domperidone treats the nausea/vomiting that accompanies migraine and also improves gastric motility (which is impaired during attacks, slowing oral drug absorption)
This is a first-line option for mild-to-moderate migraine

Step-up options if Naxdom is insufficient

1. Triptans (migraine-specific, first-line for moderate-to-severe)

5-HT₁B/1D receptor agonists — cause cranial vasoconstriction and inhibit release of vasoactive neuropeptides (CGRP, substance P)

Drug	Dose	Notes
Sumatriptan	50–100 mg oral / 6 mg SC / 20 mg nasal	Prototype; fastest SC onset
Rizatriptan	10 mg oral (wafer)	Rapid onset; good for nausea
Zolmitriptan	2.5–5 mg oral or nasal spray	Nasal useful if vomiting
Naratriptan	2.5 mg	Slower onset, fewer side effects, longer half-life
Eletriptan	40–80 mg	Highly effective
Frovatriptan	2.5 mg	Longest half-life; useful for menstrual migraine
Almotriptan	12.5 mg	Well tolerated

Triptans abort or markedly reduce migraine in ~70% of patients. They can be combined with an NSAID (like naproxen) for better efficacy — so a triptan + your Naxdom is a valid combination.

Contraindications: Coronary artery disease, uncontrolled hypertension, prior stroke, peripheral vascular disease, basilar/hemiplegic migraine.

2. Ergot Alkaloids

Dihydroergotamine (DHE) — IV/IM/nasal spray; most effective during the prodromal phase; vasoconstrictor; contraindicated in pregnancy and vascular disease
Ergotamine + caffeine (oral/rectal) — older option, more side effects

3. Other NSAIDs / Analgesics

If you need to add or switch:

Ibuprofen 400–800 mg
Aspirin 900–1000 mg (often with metoclopramide)
Ketorolac IM — useful if oral route compromised by vomiting
Indomethacin — particularly useful for indomethacin-responsive variants

⚠️ Since you've already taken naproxen (Naxdom), do not add another NSAID — combining NSAIDs increases GI and renal risk.

4. Antiemetics (standalone or adjunct)

Metoclopramide 10 mg IV/IM/oral — also has mild analgesic benefit; enhances absorption of co-administered drugs
Prochlorperazine 10 mg IM — can abort the attack on its own
Domperidone — you already have this in Naxdom

5. Newer Agents (if triptans contraindicated or fail)

Lasmiditan — 5-HT₁F agonist (ditan); no vasoconstriction → safe in cardiovascular disease
Rimegepant / Ubrogepant — CGRP receptor antagonists; effective acute options, also usable for prevention

Practical Approach

You've taken Naxdom 500. Next steps depend on response:

If mild-moderate and improving → rest in a dark, quiet room; stay hydrated; wait 1–2 hours
If not improving in 1 hour → add a triptan (e.g., sumatriptan 50 mg or rizatriptan 10 mg)
If vomiting prevents oral intake → use zolmitriptan nasal spray or sumatriptan SC
In ER/clinic setting → IV metoclopramide or IM ketorolac are highly effective

Sources: Lippincott Illustrated Reviews: Pharmacology; Bradley and Daroff's Neurology in Clinical Practice; Goodman & Gilman's Pharmacological Basis of Therapeutics

Note: This is for educational purposes. For ongoing or worsening symptoms, please consult a healthcare provider.

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