drug of choice for acute attack of migraine is -

Management of migraine Avoidance of identified triggers or exacerbating factors (such as the combined contraceptive pill) may prevent attacks. Treatment of an acute attack consists of simple analgesia with aspirin, paracetamol or non-steroidal anti-inflammatory agents. Nausea may require an antiemetic such as metoclopramide or domperidone. Severe attacks can be aboed by one of the 'triptans' (e.g. sumatriptan), which are potent 5-hydroxytryptamine (5-HT, serotonin) agonists. These can be administered the oral, subcutaneous or nasal route. Caution is needed with ergotamine preparations because they may lead to dependence. Overuse of any analgesia, including triptans, may contribute to medication overuse headache. If attacks are frequent (more than two per month), prophylaxis should be considered. Many drugs can be chosen but the most frequently used are vasoactive drugs (b-blockers), antidepressants (amitriptyline, dosulepin) and antiepileptic drugs (valproate, topiramate). Women with aura should avoid oestrogen treatment for either oral contraception or hormone replacement, although the increased risk of ischaemic stroke is minimal . Ref - Davidsons 23e p1096