Medication	Efficacy rating*	Dosage	Contraindications	Adverse reactions
Ergotamine derivatives
Ergotamine (Ergostat)†	3	1 to 2 mg orally every hour, maximum of three doses in 24 hours Use lowest effective dose Suppository: 1 mg, maximal dosage, two to three per day and 12 per month	Use of triptans, pregnancy, lactation	Increased incidence of migraines, daily headaches, ergot poisoning, tachycardia, bradycardia, arterial spasm, localized edema, numbness and tingling in extremities, nausea, vomiting, diarrhea, xerostomia
Caffeine plus ergotamine (Cafergot)	3	Two tablets (100 mg caffeine/1 mg ergotamine) at onset, then one tablet every 30 minutes, up to six tablets per attack, 10 per week Suppository (2 mg ergotamine/100 mg caffeine), one at onset, one in one hour as needed; maximal dosage, two per attack	Use of triptans	Severe reactions: myocardial infarction, myocardial or pleuropulmonary fibrosis, vasospastic ischemia Common reactions: dizziness, rash
Dihydroergotamine (DHE)†	4	1 mg IM, SC Maximal initial dose: 0.5 to 1.0 mg; can be repeated every hour to maximal dosage of 3 mg IM or 2 mg IV per day, and 6 mg per week Intranasal: one 0.5-mg spray in each nostril, followed by one spray in each nostril 15 minutes later; maximal dosage: four sprays (2 mg) per day	Triptans, beta blockers, antihypertensives, methysergide (Sansert), SSRIs, dopamine (Intropin), macrolides, nitrates, angina, CAD, clarithromycin (Biaxin), hypertension, myocardial infarction, peripheral vascular disease, pregnancy, renal impairment, sepsis, breastfeeding, ergot alkaloid sensitivity	Ergot toxicity, coronary vasospasm, cardiac events including angina, myocardial infarction, ventricular tachycardia or fibrillation, hypertension, adverse cerebrovascular events, localized edema, pruritus, sinus tachycardia or bradycardia, weakness in legs, nausea, vomiting, diarrhea, drowsiness, xerostomia, local injection reaction, numbness
Triptans‡
Sumatriptan (Imitrex)	4	6 mg SC, repeated in one hour; maximal dosage, 12 mg per 24 hours 25 to 100 mg orally every two hours, maximal dosage: 200 mg per day Maximal initial dose: 100 mg Intranasal: 5 to 10 mg (one to two sprays) in one nostril; dose may be repeated after 2 hours to maximal dosage of 40 mg per day	Ergotamine, MAOIs, use within 24 hours of another triptan, hemiplegic or basilar migraine, pregnancy, impaired hepatic function, as prophylactic therapy, CAD	Nausea, warmth, vomiting, vertigo, malaise, headache, injection site reactions, chest pressure and heaviness
Naratriptan (Amerge)	3	1.0 to 2.5 mg orally every four hours to maximal dosage of 5 mg per day	Ergot-type medications, SSRIs, oral contraceptives, smoking, CAD	Dizziness, drowsiness, nausea, vomiting, fatigue, paresthesias
Rizatriptan (Maxalt, Maxalt MLT)	4	5 to 20 mg orally every two hours to maximal dosage of 30 mg per day	Ergot-type medications, SSRIs, other triptans, MAOIs, propranolol (Inderal), cimetidine (Tagamet), CAD	Tachycardia, bradycardia, throat tightness, closure
Zolmitriptan (Zomig)	4	2.5 to 5.0 mg orally every two hours to maximal dosage of 10 mg per 24 hours	Ergot-type medications, SSRIs, other triptans, MAOIs, CAD	—