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rescue medication migraine sumatriptan acetaminophen aspirin caffeine ibuprofen guidelines

The question asks: "What might you recommend as a rescue medication for Maggie's migraines? (choose all that apply)"
The currently selected answers are:
  • ✅ Acetaminophen/Aspirin/Caffeine 1 tab
  • ✅ Acetaminophen 650mg

Correct Answers (all that apply):

The best evidence-supported rescue medications for migraines from the list are:

✅ Sumatriptan 100mg - Should be selected

Triptans are first-line acute/rescue therapy for moderate-to-severe migraines. Sumatriptan is the most widely used triptan and is a cornerstone of migraine rescue treatment.

✅ Ibuprofen 400mg - Should be selected

NSAIDs (like ibuprofen) are first-line for mild-to-moderate migraines. Evidence strongly supports their use as rescue therapy.

✅ Acetaminophen/Aspirin/Caffeine 1 tab (Excedrin Migraine) - Correctly selected

This combination (Excedrin) is FDA-approved specifically for migraines and is well-established as a rescue option. Caffeine enhances absorption and pain relief.

✅ Acetaminophen 650mg - Correctly selected

Plain acetaminophen is a reasonable first-line option, especially when NSAIDs or triptans are contraindicated.

❌ Should NOT be selected:

OptionReason
Acetaminophen/Butalbital/CaffeineButalbital-containing combinations are generally not recommended - they carry high risk of medication overuse headache (MOH) and are specifically discouraged by headache guidelines
Promethazine 25mgAn antiemetic/dopamine antagonist - used as an adjunct for nausea, not a primary rescue medication
Hydrocodone 1 tabOpioids are explicitly discouraged for migraine rescue due to MOH risk and lack of efficacy vs. triptans/NSAIDs

Summary

The correct answers to select are:
  1. Sumatriptan 100mg
  2. Ibuprofen 400mg
  3. Acetaminophen/Aspirin/Caffeine 1 tab
  4. Acetaminophen 650mg
The current selection is incomplete - Sumatriptan 100mg and Ibuprofen 400mg should also be checked. Per AAN guidelines on acute migraine treatment, triptans and NSAIDs are the mainstays of acute migraine therapy, while opioids and butalbital combinations should be avoided.
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