(FDA approved in bold)

• Migraine
  
• Cluster headache (injection only)

• Selective 5-HT1 receptor agonist, working predominantly at the B and D receptor subtypes. Effectiveness may be due to blocking the transmission of pain signals from the trigeminal nerve to the trigeminal nucleus caudalis and preventing release of inflammatory neuropeptides rather than just causing vasoconstriction
  
• Naproxen is an NSAID (cyclo-oxygenase inhibitor) which inhibits synthesis of prostaglandins, a mediator of inflammation

• Oral or NS– 1 hour or less. SC – within 10–30 minutes

• 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 – triptans are less likely to work after the development of cutaneous allodynia, a marker of central sensitization
  
• Use SC injection instead
  
• For patients with partial response or reoccurrence, use sumatriptan/naproxen combination
  
• Change to another agent

• NSAIDs or neuroleptics are often used to augment response
  
• Use sumatriptan/naproxen combination

• None required