What is first-line therapy for mild to moderate acute episodic migraine?

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For mild to moderate acute episodic migraine, the goal is rapid relief with a therapy that is effective yet has a favorable safety profile. Non-opioid analgesics such as acetaminophen or NSAIDs address the pain and inflammatory components of migraine and tend to work quickly, making them suitable as first-line options. When these are used with caffeine, the analgesic effect can be enhanced and relief can occur sooner, which is why many OTC products combine analgesics with caffeine. Triptans are effective for many patients, but they’re often reserved for more prominent or disabling attacks or when NSAIDs alone aren’t enough, because of cost, tolerability, and potential cardiovascular or drug-interaction concerns. Opioids are not preferred first-line due to risks of dependence, misuse, side effects, and a higher chance of headache chronification with overuse. If the initial non-opioid approach isn’t sufficient, escalation to a triptan (alone or with NSAID) can be considered, always guided by individual safety factors and comorbidities.