Migraine is a chronic neurological disorder and a major public health concern worldwide. Standard management of acute migraine attacks includes nonsteroidal anti-inflammatory drugs, triptans, ergot alkaloids, and antiemetics; however, their efficacy is often limited and may be associated with adverse events. This review aims to summarise current evidence on the effectiveness and safety of triptans, long-established first-line agents for the acute treatment of migraine, and the newer class of medications known as gepants.

Literature review

A systematic literature search was conducted in PubMed, Google Scholar, and the Cochrane Library (state of knowledge as of early May 2025), including studies published over the past decade, with particular emphasis on meta-analyses and randomised controlled trials. The analysis indicates that triptans remain the treatment of choice for moderate-to-severe migraine attacks. Eletriptan (40 mg orally) and sumatriptan (6 mg subcutaneously) demonstrate the highest efficacy, with sumatriptan also exhibiting the fastest onset of action. Combination therapy with sumatriptan and naproxen is more effective than monotherapy. The most common adverse events—fatigue, dizziness, somnolence, nausea, and chest discomfort—are generally mild and self-limiting. Gepants (ubrogepant, rimegepant, and zavegepant) are effective in aborting migraine attacks and alleviating associated symptoms, such as nausea, photophobia, and phonophobia. They are generally well tolerated and pose no cardiovascular risk, thereby providing a valuable alternative for patients with contraindications to triptans. The strongest clinical evidence supports the use of ubrogepant (50–100 mg) and rimegepant (75 mg).

Conclusions

In conclusion, triptans maintain a well-established role in migraine therapy, whereas gepants expand the therapeutic spectrum, enabling individualised treatment tailored to patients’ specific needs.