2026 Taiwan guidelines for the acute pharmacologic treatment of migraine in adults

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Publication Details

Journal
Journal of the Chinese Medical Association
Published
2026-09-11
DOI
https://doi.org/10.1097/jcma.0000000000001427
Primary Topic
Migraine and Headache Studies
Type
article
Field-Weighted Citation Impact
0.00
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article

2026 Taiwan guidelines for the acute pharmacologic treatment of migraine in adults

Jong‐Ling Fuh, Tzu-Chou Huang, Chi Ieong Lau, Yi-Chia Liaw et al.
Journal of the Chinese Medical Association
Migraine and Headache Studies
article

2026 Taiwan guidelines for the acute pharmacologic treatment of migraine in adults

Jong‐Ling Fuh, Tzu-Chou Huang, Chi Ieong Lau, Yi-Chia Liaw, Yen‐Feng Wang, Jen-Feng Liang, Jr‐Wei Wu, Wei‐Hung Chen, Tsung-Wei Hou, Yung‐Chu Hsu, Yi‐Hsien Tu, Chun Yang, Ching-Sen Shih, Yen-Yu Chen, Tu-Hsueh Yeh, Shuu-Jiun Wang, Shih-Pin Chen, Ping-Kun Chen, Wei-Ta Chen, Tzu-Hsien Lai, Fu-Chi Yang, Kang-Hsu Lin, Kao-Chang Lin, Chun-Pai Yang
article en

Abstract

Since the publication of the Taiwan Headache Society's 2022 Guidelines for the Acute Treatment of Migraine Attacks, advances in headache medicine and the approval of new drugs in Taiwan have necessitated an update. To address clinical needs, the Guideline Committee of the Taiwan Headache Society reviewed evidence for pharmacological and non-pharmacological acute treatments using evidence-based principles. Drawing from the latest European, American, and international guidelines, and through expert consensus, this revision updates treatment roles, grades of recommendation, efficacy, and adverse-effect profiles. Currently, a broad range of medications is available in Taiwan for acute migraine management, categorised into "specific" and "non-specific" agents. Specific treatments include oral and intranasal triptans, and gepants, i.e., oral calcitonin gene-related peptide (CGRP) receptor antagonists. Non-specific agents include acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs: diclofenac, ibuprofen, naproxen). Injectable prochlorperazine is also strongly recommended. Ergotamine/caffeine combinations are less effective and are second-line agents, while high-dose aspirin is limited by gastrointestinal risk. Considering the potential risk of dependency, tramadol or tramadol/paracetamol combinations should be reserved until all other agents fail, and should be limited to oral forms. Other opioids, such as morphine, butorphanol, etc., lack evidence and are not recommended. Treatment should follow the principle of stratified care: oral NSAIDs for mild disability, with combination analgesics or parenteral NSAIDs as alternatives, and oral or intranasal triptans for moderate to severe disability, ideally administered early. Antiemetics may be added, and combining triptans with NSAIDs enhances efficacy. Rimegepant can be considered a first-line therapy, particularly for patients who are unresponsive or intolerant to triptans, have cardiovascular contraindications, or are at risk of developing medication overuse. In status migrainosus, parenteral corticosteroids with intravenous fluids are advised. Acetaminophen remains first-line for children and pregnant women. To prevent medication-overuse headache, acute treatments, including NSAIDs, acetaminophen, triptans, ergot derivatives, and combination analgesics, should not exceed two days per week, probably with the exception of rimegepant.

Journal of the Chinese Medical Association
Fu Jen Catholic University (TW), Taiwan Livestock Research Institute (TW), Asia University (TW), National Yang Ming Chiao Tung University (TW), National Chung Hsing University (TW), China Medical University (TW), Jen-Ai Hospital (TW), Taipei Medical University Hospital (TW), Taipei Veterans General Hospital (TW), National Yang Ming University Hospital (TW), Kuang Tien General Hospital (TW), Taichung Veterans General Hospital (TW), An-Nan Hospital (TW), Far Eastern Memorial Hospital (TW), China Medical University Hospital (TW), Chi Mei Medical Center (TW), Kaohsiung Veterans General Hospital (TW), Changhua Christian Hospital (TW), Memorial Hospital (US), University College London (GB), Taipei Medical University (TW), National Defense Medical Center (TW)
Good health and well-being
Openalex Percentile: Top 10%
Migraine and Headache Studies
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