(FDA approved in bold)

• Acute migraine treatment
  
• Acute cluster headache treatment
  
• Status migrainosus

• Agonism of 5-HT1_B and _D receptors similar to triptans, but with additional actions at 5-HT1_F 5-HT1_A and 5-HT2_A receptors. Also acts at norepinephrine (inhibits reuptake) and dopamine (including D2 and D3) receptors
  
• Effectiveness and vasoconstrictive effects are likely related to agonism of 5-HT1_B and _D receptors. Blocking the transmission of pain signals from the trigeminal nerve to the trigeminal nucleus caudalis and preventing release of inflammatory neuropeptides is more likely the reason for effectiveness rather than vasoconstriction. Unlike triptans, can reverse central sensitization

• Migraine/cluster- within 1–2 hours

• Continue to take as needed. Patients taking acute treatment more than 2 days/week are at risk for medication-overuse headache, especially if they have migraine

• Treat early in the attack (before severe pain)
  
• Change to another agent

• Migraine: Non-steroidal anti-inflammatory drugs (NSAIDs) or antiemetics are often used to augment response
  
• Cluster: Oxygen (high-flow)
  
• Status migrainosus: Combine with neuroleptics, ketorolac, diphenhydramine, intravenous valproate, intravenous magnesium, hydrate and start preventive treatment

• Monitor blood pressure – especially after intravenous administration