Acute management of migraine is best achieved with which option?

• A. Triptans
• B. Beta-blockers
• C. Antidepressants
• D. Antihistamines

Answer: (A)

Triptans are best for acute migraine because they directly interrupt the ongoing attack by binding to 5-HT1B/1D receptors on cranial blood vessels and trigeminal nerve terminals. This causes constriction of dilated intracranial vessels and inhibits the release of CGRP and other pro-migraine neuropeptides, reducing trigeminal nerve activation and neurogenic inflammation. Because of this mechanism, they quickly relieve headache and associated symptoms when taken early in an attack, and come in multiple formulations (oral, nasal, injectable) to fit patient needs. They’re considered first-line for abortive therapy in patients without cardiovascular contraindications. By contrast, beta-blockers are used mainly for prevention, antidepressants for prevention or comorbidity management, and antihistamines have no established role in acute migraine treatment.