Acute Treatments for Episodic Migraine in Adults | Headache | JN Learning | AMA Ed Hub [Skip to Content]
Outline
Quiz
PDF
Pain Medicine

Acute Treatments for Episodic Migraine in AdultsA Systematic Review and Meta-analysis

Educational Objective
To review the acute treatment of patients with episodic migraine.
1 Credit CME
JAMA
June 15, 2021
Original Investigation
Juliana H. VanderPluym, MD1,2;
Rashmi B. Halker Singh, MD1,2;
Meritxell Urtecho, MD1,3;
Allison S. Morrow, BA1,3;
Tarek Nayfeh, MD1,3;
Victor D. Torres Roldan, MD1,3;
Magdoleen H. Farah, MBBS1,3;
Bashar Hasan, MD1,3;
Samer Saadi, MD1,3;
Sahrish Shah, MBBS1,3;
Rami Abd-Rabu, MBBS1,3;
Lubna Daraz, PhD1,3;
Larry J. Prokop, MLS4;
Mohammad Hassan Murad, MD, MPH1,3;
Zhen Wang, PhD1,3,5
Author Affiliations
  • 1Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
  • 2Department of Neurology, Mayo Clinic, Scottsdale, Arizona
  • 3Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
  • 4Department of Library–Public Services, Mayo Clinic, Rochester, Minnesota
  • 5Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota
Read article on JAMA Network

MOC/CME Information

editorial comment icon
Editorial
Comment
 related articles icon
Related
Articles
 author interview icon
Interviews
 multimedia icon
Multimedia
Audio Clinical Review (23:16)
Diagnosis and Management of Headache, Part 1
Audio Clinical Review (22:34)
Diagnosis and Management of Headache, Part 2
Read Article Take Quiz
Key Points

Question  What are the benefits and adverse events associated with acute treatments for episodic migraine in adults?

Findings  In this systematic review and meta-analysis that included 15 systematic reviews and 115 randomized clinical trials of 28 803 participants with migraine headache, multiple acute interventions, including nonsteroidal anti-inflammatory drugs, triptans, calcitonin gene-related peptide receptor antagonists, 5-HT1F receptor agonist, dihydroergotamine, acetaminophen, and remote electrical neuromodulation, were associated with improvements in short-term pain outcomes, with moderate to high strength of evidence. The evidence for these end points regarding opioids and other interventions was low or insufficient.

Meaning  For the acute treatment of migraine, several established and newer therapies were associated with improvements in short-term pain outcomes, with varying strengths of evidence.

Abstract

Importance  Migraine is common and can be associated with significant morbidity, and several treatment options exist for acute therapy.

Objective  To evaluate the benefits and harms associated with acute treatments for episodic migraine in adults.

Data Sources  Multiple databases from database inception to February 24, 2021.

Study Selection  Randomized clinical trials and systematic reviews that assessed effectiveness or harms of acute therapy for migraine attacks.

Data Extraction and Synthesis  Independent reviewers selected studies and extracted data. Meta-analysis was performed with the DerSimonian-Laird random-effects model with Hartung-Knapp-Sidik-Jonkman variance correction or by using a fixed-effect model based on the Mantel-Haenszel method if the number of studies was small.

Main Outcomes and Measures  The main outcomes included pain freedom, pain relief, sustained pain freedom, sustained pain relief, and adverse events. The strength of evidence (SOE) was graded with the Agency for Healthcare Research and Quality Methods Guide for Effectiveness and Comparative Effectiveness Reviews.

Findings  Evidence on triptans and nonsteroidal anti-inflammatory drugs was summarized from 15 systematic reviews. For other interventions, 115 randomized clinical trials with 28 803 patients were included. Compared with placebo, triptans and nonsteroidal anti-inflammatory drugs used individually were significantly associated with reduced pain at 2 hours and 1 day (moderate to high SOE) and increased risk of mild and transient adverse events. Compared with placebo, calcitonin gene-related peptide receptor antagonists (low to high SOE), lasmiditan (5-HT1F receptor agonist; high SOE), dihydroergotamine (moderate to high SOE), ergotamine plus caffeine (moderate SOE), acetaminophen (moderate SOE), antiemetics (low SOE), butorphanol (low SOE), and tramadol in combination with acetaminophen (low SOE) were significantly associated with pain reduction and increase in mild adverse events. The findings for opioids were based on low or insufficient SOE. Several nonpharmacologic treatments were significantly associated with improved pain, including remote electrical neuromodulation (moderate SOE), transcranial magnetic stimulation (low SOE), external trigeminal nerve stimulation (low SOE), and noninvasive vagus nerve stimulation (moderate SOE). No significant difference in adverse events was found between nonpharmacologic treatments and sham.

Conclusions and Relevance  There are several acute treatments for migraine, with varying strength of supporting evidence. Use of triptans, nonsteroidal anti-inflammatory drugs, acetaminophen, dihydroergotamine, calcitonin gene-related peptide antagonists, lasmiditan, and some nonpharmacologic treatments was associated with improved pain and function. The evidence for many other interventions, including opioids, was limited.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

Related Articles

  1. Who Should Try New Antibody Treatments for Migraine?

  2. Evaluation of Galcanezumab for the Prevention of Episodic Migraine

  3. Sumatriptan Treatment During a Migraine and Central 5-HT1B Receptor Binding

  4. Effect of Ubrogepant vs Placebo on Pain Among Patients With Acute Migraine Headaches
    1.00 CME

  5. Pharmacologic Acute and Preventive Treatment for Migraine in Children and Adolescents

  6. New Migraine Drug Gains Approval

  7. Rimegepant (Nurtec ODT) for Acute Treatment of Migraine

  8. Oral Rimegepant Safe, Effective for Migraine Prevention

  9. Safety of CGRP Antagonists for Migraine in Adults With Raynaud Phenomenon

  10. Diagnosis and Management of Headache
    1.00 CME

  11. Effects of Eptinezumab vs Placebo on Headache Pain and Most Bothersome Symptom in Migraine Attack
    1.00 CME

  12. Acute Treatment for Migraine

  13. Systematic Review and Meta-analysis of Acute Treatments for Episodic Migraine in Adults—Reply

  14. Systematic Review and Meta-analysis of Acute Treatments for Episodic Migraine in Adults

  15. Systematic Review and Meta-analysis of Acute Treatments for Episodic Migraine in Adults

See More

Related Multimedia

  1. Diagnosis and Management of Headache, Part 1

  2. Diagnosis and Management of Headache, Part 2

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

See More About

Headache Neurology Pain Medicine
Article Information

Corresponding Author: Zhen Wang, PhD, Health Care Delivery Research, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (wang.zhen@mayo.edu).

Accepted for Publication: May 3, 2021.

Author Contributions: Drs VanderPluym and Wang had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: VanderPluym, Halker Singh, Nayfeh, Farah, Saadi, Murad, Wang.

Acquisition, analysis, or interpretation of data: VanderPluym, Halker Singh, Urtecho, Morrow, Nayfeh, Torres Roldan, Hasan, Saadi, Shah, Abd-Rabu, Daraz, Prokop, Murad, Wang.

Drafting of the manuscript: VanderPluym, Halker Singh, Urtecho, Torres Roldan, Farah, Saadi, Abd-Rabu, Murad, Wang.

Critical revision of the manuscript for important intellectual content: VanderPluym, Halker Singh, Urtecho, Morrow, Nayfeh, Torres Roldan, Farah, Hasan, Saadi, Shah, Daraz, Prokop, Murad, Wang.

Statistical analysis: Halker Singh, Nayfeh, Saadi, Murad, Wang.

Obtained funding: Murad, Wang.

Administrative, technical, or material support: Halker Singh, Urtecho, Morrow, Nayfeh, Farah, Hasan, Saadi, Shah, Murad, Wang.

Supervision: VanderPluym, Halker Singh, Urtecho, Abd-Rabu, Wang.

Conflict of Interest Disclosures: Dr VanderPluym reports consulting for Teva and receiving a research grant from Amgen. Dr Halker Singh reports consulting for Teva and Impel. No other disclosures were reported.

Funding/Support: This project was funded under contract HHSA290201500013I task order 75Q80119F32007 from the Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services (HHS).

Role of the Funder/Sponsor: Mayo Clinic was awarded the contract by AHRQ to conduct this review through a competitive bidding process. A representative from AHRQ served as a Contracting Officer’s Technical Representative and provided technical assistance during the conduct of the full evidence report and provided comment on draft versions of the full evidence report. AHRQ did not directly participate in the literature search, design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The authors of this article are responsible for its content. Statement in the article does not necessarily represent the official views of or imply endorsement by AHRQ or HHS.

References
1.
GBD 2016 Headache Collaborators.  Global, regional, and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.   Lancet Neurol. 2018;17(11):954-976. doi:10.1016/S1474-4422(18)30322-3PubMedGoogle ScholarCrossref
2.
Vos  T , Lim  SS , Abbafati  C ,  et al  Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019.   Lancet. 2020;396(10258):1204-1222. doi:10.1016/S0140-6736(20)30925-9Google ScholarCrossref
3.
 Headache Classification Committee of the International Headache Society (IHS): the International Classification of Headache Disorders, 3rd edition.   Cephalalgia. 2018;38(1):1-211. doi:10.1177/0333102417738202PubMedGoogle ScholarCrossref
4.
Charleston IV  L , Burke  JF .  Do racial/ethnic disparities exist in recommended migraine treatments in US ambulatory care?   Cephalalgia. 2018;38(5):876-882. doi:10.1177/0333102417716933PubMedGoogle ScholarCrossref
5.
Sterne  JAC , Savović  J , Page  MJ ,  et al.  RoB 2: a revised tool for assessing risk of bias in randomised trials.   BMJ. 2019;366:l4898. doi:10.1136/bmj.l4898PubMedGoogle ScholarCrossref
6.
Viswanathan  M , Patnode  CD , Berkman  ND ,  et al.  Recommendations for assessing the risk of bias in systematic reviews of health-care interventions.   J Clin Epidemiol. 2018;97:26-34. doi:10.1016/j.jclinepi.2017.12.004PubMedGoogle ScholarCrossref
7.
Shea  BJ , Grimshaw  JM , Wells  GA ,  et al.  Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews.   BMC Med Res Methodol. 2007;7:10. doi:10.1186/1471-2288-7-10PubMedGoogle ScholarCrossref
8.
Li  T , Yu  T , Hawkins  BS , Dickersin  K .  Design, analysis, and reporting of crossover trials for inclusion in a meta-analysis.   PLoS One. 2015;10(8):e0133023. doi:10.1371/journal.pone.0133023PubMedGoogle Scholar
9.
Röver  C , Knapp  G , Friede  T .  Hartung-Knapp-Sidik-Jonkman approach and its modification for random-effects meta-analysis with few studies.   BMC Med Res Methodol. 2015;15:99. doi:10.1186/s12874-015-0091-1PubMedGoogle ScholarCrossref
10.
Agency for Healthcare Research and Quality. Methods Guide for Effectiveness and Comparative Effectiveness Reviews. Agency for Healthcare Research and Quality; 2014.
11.
Ashcroft  DM , Millson  D .  Naratriptan for the treatment of acute migraine: meta-analysis of randomised controlled trials.   Pharmacoepidemiol Drug Saf. 2004;13(2):73-82. doi:10.1002/pds.890PubMedGoogle ScholarCrossref
12.
Bird  S , Derry  S , Moore  RA .  Zolmitriptan for acute migraine attacks in adults.   Cochrane Database Syst Rev. 2014;2014(5):CD008616.Google Scholar
13.
Ferrari  MD , Loder  E , McCarroll  KA , Lines  CR .  Meta-analysis of rizatriptan efficacy in randomized controlled clinical trials.   Cephalalgia. 2001;21(2):129-136. doi:10.1046/j.1468-2982.2001.00169.xPubMedGoogle ScholarCrossref
14.
Poolsup  N , Leelasangaluk  V , Jittangtrong  J , Rithlamlert  C , Ratanapantamanee  N , Khanthong  M .  Efficacy and tolerability of frovatriptan in acute migraine treatment: systematic review of randomized controlled trials.   J Clin Pharm Ther. 2005;30(6):521-532. doi:10.1111/j.1365-2710.2005.00677.xPubMedGoogle ScholarCrossref
15.
Chen  L-C , Ashcroft  DM .  Meta-analysis examining the efficacy and safety of almotriptan in the acute treatment of migraine.   Headache. 2007;47(8):1169-1177. doi:10.1111/j.1526-4610.2007.00884.xPubMedGoogle ScholarCrossref
16.
Derry  CJ , Derry  S , Moore  RA .  Sumatriptan (oral route of administration) for acute migraine attacks in adults.   Cochrane Database Syst Rev. 2012;(2):CD008615. doi:10.1002/14651858.CD008615.pub2PubMedGoogle Scholar
17.
Derry  CJ , Derry  S , Moore  RA .  Sumatriptan (subcutaneous route of administration) for acute migraine attacks in adults.   Cochrane Database Syst Rev. 2012;(2):CD009665. doi:10.1002/14651858.CD009665PubMedGoogle Scholar
18.
Derry  S , Rabbie  R , Moore  RA .  Diclofenac with or without an antiemetic for acute migraine headaches in adults.   Cochrane Database Syst Rev. 2013;(4):CD008783. doi:10.1002/14651858.CD008783.pub3PubMedGoogle Scholar
19.
Rabbie  R , Derry  S , Moore  RA .  Ibuprofen with or without an antiemetic for acute migraine headaches in adults.   Cochrane Database Syst Rev. 2013;2013(4):CD008039. doi:10.1002/14651858.CD008039.pub3PubMedGoogle Scholar
20.
Kirthi  V , Derry  S , Moore  RA .  Aspirin with or without an antiemetic for acute migraine headaches in adults.   Cochrane Database Syst Rev. 2013;(4):CD008041. doi:10.1002/14651858.CD008041.pub3PubMedGoogle Scholar
21.
Law  S , Derry  S , Moore  RA .  Sumatriptan plus naproxen for the treatment of acute migraine attacks in adults.   Cochrane Database Syst Rev. 2016;4(4):CD008541. doi:10.1002/14651858.CD008541.pub3PubMedGoogle Scholar
22.
Croop  R , Goadsby  PJ , Stock  DA ,  et al.  Efficacy, safety, and tolerability of rimegepant orally disintegrating tablet for the acute treatment of migraine: a randomised, phase 3, double-blind, placebo-controlled trial.   Lancet. 2019;394(10200):737-745. doi:10.1016/S0140-6736(19)31606-XPubMedGoogle ScholarCrossref
23.
Lipton  RB , Croop  R , Stock  EG ,  et al.  Rimegepant, an oral calcitonin gene-related peptide receptor antagonist, for migraine.   N Engl J Med. 2019;381(2):142-149. doi:10.1056/NEJMoa1811090PubMedGoogle ScholarCrossref
24.
Marcus  R , Goadsby  PJ , Dodick  D , Stock  D , Manos  G , Fischer  TZ .  BMS-927711 for the acute treatment of migraine: a double-blind, randomized, placebo controlled, dose-ranging trial.   Cephalalgia. 2014;34(2):114-125. doi:10.1177/0333102413500727PubMedGoogle ScholarCrossref
25.
Voss  T , Lipton  RB , Dodick  DW ,  et al.  A phase IIb randomized, double-blind, placebo-controlled trial of ubrogepant for the acute treatment of migraine.   Cephalalgia. 2016;36(9):887-898. doi:10.1177/0333102416653233PubMedGoogle ScholarCrossref
26.
Dodick  DW , Lipton  RB , Ailani  J ,  et al.  Ubrogepant for the treatment of migraine.   N Engl J Med. 2019;381(23):2230-2241. doi:10.1056/NEJMoa1813049PubMedGoogle ScholarCrossref
27.
Lipton  RB , Dodick  DW , Ailani  J ,  et al.  Effect of ubrogepant vs placebo on pain and the most bothersome associated symptom in the acute treatment of migraine: the ACHIEVE II randomized clinical trial.   JAMA. 2019;322(19):1887-1898. doi:10.1001/jama.2019.16711PubMedGoogle ScholarCrossref
28.
Brandes  JL , Klise  S , Krege  JH ,  et al.  Interim results of a prospective, randomized, open-label, phase 3 study of the long-term safety and efficacy of lasmiditan for acute treatment of migraine (the GLADIATOR study).   Cephalalgia. 2019;39(11):1343-1357. doi:10.1177/0333102419864132PubMedGoogle ScholarCrossref
29.
Färkkilä  M , Diener  H-C , Géraud  G ,  et al; COL MIG-202 Study Group.  Efficacy and tolerability of lasmiditan, an oral 5-HT(1F) receptor agonist, for the acute treatment of migraine: a phase 2 randomised, placebo-controlled, parallel-group, dose-ranging study.   Lancet Neurol. 2012;11(5):405-413. doi:10.1016/S1474-4422(12)70047-9PubMedGoogle ScholarCrossref
30.
Ferrari  MD , Färkkilä  M , Reuter  U ,  et al; European COL-144 Investigators.  Acute treatment of migraine with the selective 5-HT1F receptor agonist lasmiditan: a randomised proof-of-concept trial.   Cephalalgia. 2010;30(10):1170-1178. doi:10.1177/0333102410375512PubMedGoogle ScholarCrossref
31.
Goadsby  PJ , Wietecha  LA , Dennehy  EB ,  et al.  Phase 3 randomized, placebo-controlled, double-blind study of lasmiditan for acute treatment of migraine.   Brain. 2019;142(7):1894-1904. doi:10.1093/brain/awz134PubMedGoogle ScholarCrossref
32.
Kuca  B , Silberstein  SD , Wietecha  L , Berg  PH , Dozier  G , Lipton  RB ; COL MIG-301 Study Group.  Lasmiditan is an effective acute treatment for migraine: a phase 3 randomized study.   Neurology. 2018;91(24):e2222-e2232. doi:10.1212/WNL.0000000000006641PubMedGoogle ScholarCrossref
33.
Brandes  JL , Klise  S , Krege  JH ,  et al  Long-term safety and efficacy of lasmiditan for acute treatment of migraine: final results of the GLADIATOR study.   Cephalalgia Rep. 2020;3. doi:10.1177/2515816320958176Google Scholar
34.
Ashina  M , Reuter  U , Smith  T ,  et al.  Randomized, controlled trial of lasmiditan over four migraine attacks: findings from the CENTURION study.   Cephalalgia. 2021;41(3):294-304. doi:10.1177/0333102421989232PubMedGoogle ScholarCrossref
35.
Knievel  K , Buchanan  AS , Lombard  L ,  et al.  Lasmiditan for the acute treatment of migraine: subgroup analyses by prior response to triptans.   Cephalalgia. 2020;40(1):19-27. doi:10.1177/0333102419889350PubMedGoogle ScholarCrossref
36.
Amiri  H , Ghodrati  N , Nikuyeh  M , Shams-Vahdati  S , Jalilzadeh-Binazar  M .  Comparison of granisetron and metoclopramide in the treatment of pain and emesis in migraine patients: a randomized controlled trial study.   Turk J Emerg Med. 2017;17(2):61-64. doi:10.1016/j.tjem.2016.12.004PubMedGoogle ScholarCrossref
37.
Bigal  ME , Bordini  CA , Speciali  JG .  Intravenous chlorpromazine in the emergency department treatment of migraines: a randomized controlled trial.   J Emerg Med. 2002;23(2):141-148. doi:10.1016/S0736-4679(02)00502-4PubMedGoogle ScholarCrossref
38.
Cameron  JD , Lane  PL , Speechley  M .  Intravenous chlorpromazine vs intravenous metoclopramide in acute migraine headache.   Acad Emerg Med. 1995;2(7):597-602. doi:10.1111/j.1553-2712.1995.tb03596.xPubMedGoogle ScholarCrossref
39.
Cete  Y , Dora  B , Ertan  C , Ozdemir  C , Oktay  C .  A randomized prospective placebo-controlled study of intravenous magnesium sulphate vs metoclopramide in the management of acute migraine attacks in the emergency department.   Cephalalgia. 2005;25(3):199-204. doi:10.1111/j.1468-2982.2004.00840.xPubMedGoogle ScholarCrossref
40.
Coppola  M , Yealy  DM , Leibold  RA .  Randomized, placebo-controlled evaluation of prochlorperazine versus metoclopramide for emergency department treatment of migraine headache.   Ann Emerg Med. 1995;26(5):541-546. doi:10.1016/S0196-0644(95)70001-3PubMedGoogle ScholarCrossref
41.
Corbo  J , Esses  D , Bijur  PE , Iannaccone  R , Gallagher  EJ .  Randomized clinical trial of intravenous magnesium sulfate as an adjunctive medication for emergency department treatment of migraine headache.   Ann Emerg Med. 2001;38(6):621-627. doi:10.1067/mem.2001.119424PubMedGoogle ScholarCrossref
42.
Dexter  SL , Graham  AN , Johnston  ES , Ratcliffe  DM , Wilkinson  MI , Rose  AJ .  Double-blind controlled study of Paramax in the acute treatment of common and classical migraine.   Br J Clin Pract. 1985;39(10):388-392.PubMedGoogle Scholar
43.
Doğan  NO , Pekdemir  M , Yılmaz  S ,  et al.  Intravenous metoclopramide in the treatment of acute migraines: a randomized, placebo-controlled trial.   Acta Neurol Scand. 2019;139(4):334-339. doi:10.1111/ane.13063PubMedGoogle ScholarCrossref
44.
Fernando  T , Lumanauw  DD , Youn  S ,  et al.  Buccally absorbed vs intravenous prochlorperazine for treatment of migraines headaches.   Acta Neurol Scand. 2019;140(1):72-77. doi:10.1111/ane.13104PubMedGoogle ScholarCrossref
45.
Friedman  BW , Esses  D , Solorzano  C ,  et al.  A randomized controlled trial of prochlorperazine versus metoclopramide for treatment of acute migraine.   Ann Emerg Med. 2008;52(4):399-406. doi:10.1016/j.annemergmed.2007.09.027PubMedGoogle ScholarCrossref
46.
Friedman  BW , Mulvey  L , Esses  D ,  et al.  Metoclopramide for acute migraine: a dose-finding randomized clinical trial.   Ann Emerg Med. 2011;57(5):475-82.e1. doi:10.1016/j.annemergmed.2010.11.023PubMedGoogle ScholarCrossref
47.
Friedman  BW , Cabral  L , Adewunmi  V ,  et al.  Diphenhydramine as adjuvant therapy for acute migraine: an emergency department–based randomized clinical trial.   Ann Emerg Med. 2016;67(1):32-39.e3. doi:10.1016/j.annemergmed.2015.07.495PubMedGoogle ScholarCrossref
48.
Gaffigan  ME , Bruner  DI , Wason  C , Pritchard  A , Frumkin  K ; Intravenous Metoclopramide for Acute Migraine Therapy in the Emergency Department.  A randomized controlled trial of intravenous haloperidol vs intravenous metoclopramide for acute migraine therapy in the emergency department.   J Emerg Med. 2015;49(3):326-334. doi:10.1016/j.jemermed.2015.03.023PubMedGoogle ScholarCrossref
49.
Honkaniemi  J , Liimatainen  S , Rainesalo  S , Sulavuori  S .  Haloperidol in the acute treatment of migraine: a randomized, double-blind, placebo-controlled study.   Headache. 2006;46(5):781-787. doi:10.1111/j.1526-4610.2006.00438.xPubMedGoogle ScholarCrossref
50.
Jones  EB , Gonzalez  ER , Boggs  JG , Grillo  JA , Elswick  RK  Jr .  Safety and efficacy of rectal prochlorperazine for the treatment of migraine in the emergency department.   Ann Emerg Med. 1994;24(2):237-241. doi:10.1016/S0196-0644(94)70135-0PubMedGoogle ScholarCrossref
51.
Jones  J , Pack  S , Chun  E .  Intramuscular prochlorperazine versus metoclopramide as single-agent therapy for the treatment of acute migraine headache.   Am J Emerg Med. 1996;14(3):262-264. doi:10.1016/S0735-6757(96)90171-0PubMedGoogle ScholarCrossref
52.
McEwen  JI , O’Connor  HM , Dinsdale  HB .  Treatment of migraine with intramuscular chlorpromazine.   Ann Emerg Med. 1987;16(7):758-763. doi:10.1016/S0196-0644(87)80569-3PubMedGoogle ScholarCrossref
53.
Miller  MA , Levsky  ME , Enslow  W , Rosin  A .  Randomized evaluation of octreotide vs prochlorperazine for ED treatment of migraine headache.   Am J Emerg Med. 2009;27(2):160-164. doi:10.1016/j.ajem.2008.01.015PubMedGoogle ScholarCrossref
54.
Rowat  BM , Merrill  CF , Davis  A , South  V .  A double-blind comparison of granisetron and placebo for the treatment of acute migraine in the emergency department.   Cephalalgia. 1991;11(5):207-213. doi:10.1046/j.1468-2982.1991.1105207.xPubMedGoogle ScholarCrossref
55.
Salazar  G , Fragoso  M , Vergez  L , Sergio  P , Cuello  D .  Metoclopramide as an analgesic in severe migraine attacks: an open, single-blind, parallel control study.   Recent Pat CNS Drug Discov. 2011;6(2):141-145. doi:10.2174/157488911795933947PubMedGoogle ScholarCrossref
56.
Shahrami  A , Assarzadegan  F , Hatamabadi  HR , Asgarzadeh  M , Sarehbandi  B , Asgarzadeh  S .  Comparison of therapeutic effects of magnesium sulfate vs dexamethasone/metoclopramide on alleviating acute migraine headache.   J Emerg Med. 2015;48(1):69-76. doi:10.1016/j.jemermed.2014.06.055PubMedGoogle ScholarCrossref
57.
Silberstein  SD , Young  WB , Mendizabal  JE , Rothrock  JF , Alam  AS .  Acute migraine treatment with droperidol: a randomized, double-blind, placebo-controlled trial.   Neurology. 2003;60(2):315-321. doi:10.1212/01.WNL.0000042477.63516.B2PubMedGoogle ScholarCrossref
58.
Tek  DS , McClellan  DS , Olshaker  JS , Allen  CL , Arthur  DC .  A prospective, double-blind study of metoclopramide hydrochloride for the control of migraine in the emergency department.   Ann Emerg Med. 1990;19(10):1083-1087. doi:10.1016/S0196-0644(05)81508-2PubMedGoogle ScholarCrossref
59.
Tanen  DA , Miller  S , French  T , Riffenburgh  RH .  Intravenous sodium valproate versus prochlorperazine for the emergency department treatment of acute migraine headaches: a prospective, randomized, double-blind trial.   Ann Emerg Med. 2003;41(6):847-853. doi:10.1067/mem.2003.195PubMedGoogle ScholarCrossref
60.
Kandil  M , Jaber  S , Desai  D ,  et al.  MAGraine: Magnesium compared to conventional therapy for treatment of migraines.   Am J Emerg Med. 2021;39:28-33.PubMedGoogle ScholarCrossref
61.
Motamed  H , Mozafari  J , Porozan  S , Sasani  M .  Magnesium sulfate and acute migraine: a randomized clinical trial.   Ann Clin Anal Med. 2020;11(5):369-373.Google Scholar
62.
Aurora  SK , Silberstein  SD , Kori  SH ,  et al.  MAP0004, orally inhaled DHE: a randomized, controlled study in the acute treatment of migraine.   Headache. 2011;51(4):507-517. doi:10.1111/j.1526-4610.2011.01869.xPubMedGoogle ScholarCrossref
63.
Aurora  SK , Rozen  TD , Kori  SH , Shrewsbury  SB .  A randomized, double blind, placebo-controlled study of MAP0004 in adult patients with migraine.   Headache. 2009;49(6):826-837. doi:10.1111/j.1526-4610.2009.01453.xPubMedGoogle ScholarCrossref
64.
Bell  R , Montoya  D , Shuaib  A , Lee  MA .  A comparative trial of three agents in the treatment of acute migraine headache.   Ann Emerg Med. 1990;19(10):1079-1082. doi:10.1016/S0196-0644(05)81507-0PubMedGoogle ScholarCrossref
65.
Callaham  M , Raskin  N .  A controlled study of dihydroergotamine in the treatment of acute migraine headache.   Headache. 1986;26(4):168-171. doi:10.1111/j.1526-4610.1986.hed2604168.xPubMedGoogle ScholarCrossref
66.
Diener  H-C , Jansen  J-P , Reches  A , Pascual  J , Pitei  D , Steiner  TJ ; Eletriptan and Cafergot Comparative Study Group.  Efficacy, tolerability and safety of oral eletriptan and ergotamine plus caffeine (Cafergot) in the acute treatment of migraine: a multicentre, randomised, double-blind, placebo-controlled comparison.   Eur Neurol. 2002;47(2):99-107. doi:10.1159/000047960PubMedGoogle ScholarCrossref
67.
Friedman  AP , Di Serio  FJ , Hwang  DS .  Symptomatic relief of migraine: multicenter comparison of Cafergot P-B, Cafergot, and placebo.   Clin Ther. 1989;11(1):170-182.PubMedGoogle Scholar
68.
Gallagher  RM ; Dihydroergotamine Working Group.  Acute treatment of migraine with dihydroergotamine nasal spray.   Arch Neurol. 1996;53(12):1285-1291. doi:10.1001/archneur.1996.00550120097022PubMedGoogle ScholarCrossref
69.
Hakkarainen  H , Allonen  H .  Ergotamine vs metoclopramide vs their combination in acute migraine attacks.   Headache. 1982;22(1):10-12. doi:10.1111/j.1526-4610.1982.hed2201010.xPubMedGoogle ScholarCrossref
70.
Kangasniemi  P , Kaaja  R .  Ketoprofen and ergotamine in acute migraine.   J Intern Med. 1992;231(5):551-554. doi:10.1111/j.1365-2796.1992.tb00973.xPubMedGoogle ScholarCrossref
71.
Rapoport  A , Sheftell  F , Couch  J ,  et al; Dihydroergotamine Nasal Spray Multicenter Investigators.  Efficacy, safety, and tolerability of dihydroergotamine nasal spray as monotherapy in the treatment of acute migraine.   Headache. 1995;35(4):177-184. doi:10.1111/j.1526-4610.1995.hed3504177.xPubMedGoogle ScholarCrossref
72.
Ryan  RE .  Double-blind clinical evaluation of the efficacy and safety of ergostine-caffeine, ergotamine-caffeine, and placebo in migraine headache.   Headache. 1970;9(4):212-220. doi:10.1111/j.1526-4610.1970.hed0904212.xPubMedGoogle ScholarCrossref
73.
Sharma  S , Prasad  A , Nehru  R ,  et al.  Efficacy and tolerability of prochlorperazine buccal tablets in treatment of acute migraine.   Headache. 2002;42(9):896-902. doi:10.1046/j.1526-4610.2002.02210.xPubMedGoogle ScholarCrossref
74.
Treves  TA , Kuritzky  A , Hering  R , Korczyn  AD .  Dihydroergotamine nasal spray in the treatment of acute migraine.   Headache. 1998;38(8):614-617. doi:10.1046/j.1526-4610.1998.3808614.xPubMedGoogle ScholarCrossref
75.
Tulunay  FC , Karan  O , Aydin  N , Culcuoglu  A , Guvener  A .  Dihydroergotamine nasal spray during migraine attacks: a double-blind crossover study with placebo.   Cephalalgia. 1987;7(2):131-133. doi:10.1046/j.1468-2982.1987.0702131.xPubMedGoogle ScholarCrossref
76.
Ziegler  D , Ford  R , Kriegler  J ,  et al.  Dihydroergotamine nasal spray for the acute treatment of migraine.   Neurology. 1994;44(3 pt 1):447-453. doi:10.1212/WNL.44.3_Part_1.447PubMedGoogle ScholarCrossref
77.
Alemdar  M , Pekdemir  M , Selekler  HM .  Single-dose intravenous tramadol for acute migraine pain in adults: a single-blind, prospective, randomized, placebo-controlled clinical trial.   Clin Ther. 2007;29(7):1441-1447. doi:10.1016/j.clinthera.2007.07.017PubMedGoogle ScholarCrossref
78.
Boureau  F , Joubert  JM , Lasserre  V , Prum  B , Delecoeuillerie  G .  Double-blind comparison of an acetaminophen 400 mg–codeine 25 mg combination versus aspirin 1000 mg and placebo in acute migraine attack.   Cephalalgia. 1994;14(2):156-161. doi:10.1046/j.1468-2982.1994.1402156.xPubMedGoogle ScholarCrossref
79.
Carleton  SC , Shesser  RF , Pietrzak  MP ,  et al.  Double-blind, multicenter trial to compare the efficacy of intramuscular dihydroergotamine plus hydroxyzine versus intramuscular meperidine plus hydroxyzine for the emergency department treatment of acute migraine headache.   Ann Emerg Med. 1998;32(2):129-138. doi:10.1016/S0196-0644(98)70126-XPubMedGoogle ScholarCrossref
80.
Freitag  FG .  The acute treatment of migraine with transnasal butorphanol (TNB).   Headache Q. 1993;4(suppl 3):22-28.Google Scholar
81.
Friedman  BW , Irizarry  E , Solorzano  C ,  et al.  Randomized study of IV prochlorperazine plus diphenhydramine vs IV hydromorphone for migraine.   Neurology. 2017;89(20):2075-2082. doi:10.1212/WNL.0000000000004642PubMedGoogle ScholarCrossref
82.
Hoffert  MJ , Couch  JR , Diamond  S ,  et al.  Transnasal butorphanol in the treatment of acute migraine.   Headache. 1995;35(2):65-69. doi:10.1111/j.1526-4610.1995.hed3502065.xPubMedGoogle ScholarCrossref
83.
Klapper  JA , Stanton  J .  Current emergency treatment of severe migraine headaches.   Headache. 1993;33(10):560-562. doi:10.1111/j.1526-4610.1993.hed3310560.xPubMedGoogle ScholarCrossref
84.
Lane  PL , McLellan  BA , Baggoley  CJ .  Comparative efficacy of chlorpromazine and meperidine with dimenhydrinate in migraine headache.   Ann Emerg Med. 1989;18(4):360-365. doi:10.1016/S0196-0644(89)80570-0PubMedGoogle ScholarCrossref
85.
Richman  PB , Allegra  J , Eskin  B ,  et al.  A randomized clinical trial to assess the efficacy of intramuscular droperidol for the treatment of acute migraine headache.   Am J Emerg Med. 2002;20(1):39-42. doi:10.1053/ajem.2002.30007PubMedGoogle ScholarCrossref
86.
Scherl  ER , Wilson  JF .  Comparison of dihydroergotamine with metoclopramide versus meperidine with promethazine in the treatment of acute migraine.   Headache. 1995;35(5):256-259. doi:10.1111/j.1526-4610.1995.hed3505256.xPubMedGoogle ScholarCrossref
87.
Silberstein  SD , Freitag  FG , Rozen  TD ,  et al; CAPSS-223 Investigators.  Tramadol/acetaminophen for the treatment of acute migraine pain: findings of a randomized, placebo-controlled trial.   Headache. 2005;45(10):1317-1327. doi:10.1111/j.1526-4610.2005.00264.xPubMedGoogle ScholarCrossref
88.
Stiell  IG , Dufour  DG , Moher  D , Yen  M , Beilby  WJ , Smith  NA .  Methotrimeprazine versus meperidine and dimenhydrinate in the treatment of severe migraine: a randomized, controlled trial.   Ann Emerg Med. 1991;20(11):1201-1205. doi:10.1016/S0196-0644(05)81471-4PubMedGoogle ScholarCrossref
89.
Taheraghdam  AA , Amiri  H , Shojaan  H , Shamsvahdati  S , Houshyar  Y .  Intravenous dexamethasone versus morphine in relieving of acute migraine headache.   Pak J Biol Sci. 2011;14(12):682-687. doi:10.3923/pjbs.2011.682.687PubMedGoogle ScholarCrossref
90.
Borhani Haghighi  A , Motazedian  S , Rezaii  R ,  et al.  Cutaneous application of menthol 10% solution as an abortive treatment of migraine without aura: a randomised, double-blind, placebo-controlled, crossed-over study.   Int J Clin Pract. 2010;64(4):451-456. doi:10.1111/j.1742-1241.2009.02215.xPubMedGoogle ScholarCrossref
91.
Chou  DE , Shnayderman Yugrakh  M , Winegarner  D , Rowe  V , Kuruvilla  D , Schoenen  J .  Acute migraine therapy with external trigeminal neurostimulation (ACME): a randomized controlled trial.   Cephalalgia. 2019;39(1):3-14. doi:10.1177/0333102418811573PubMedGoogle ScholarCrossref
92.
Farahmand  S , Shafazand  S , Alinia  E , Bagheri-Hariri  S , Baratloo  A .  Pain management using acupuncture method in migraine headache patients: a single blinded randomized clinical trial.   Anesth Pain Med. 2018;8(6):e81688. doi:10.5812/aapm.81688PubMedGoogle Scholar
93.
Fuglsang  CH , Johansen  T , Kaila  K , Kasch  H , Bach  FW .  Treatment of acute migraine by a partial rebreathing device: a randomized controlled pilot study.   Cephalalgia. 2018;38(10):1632-1643. doi:10.1177/0333102418797285PubMedGoogle ScholarCrossref
94.
Korucu  O , Dagar  S , Çorbacioglu  SK , Emektar  E , Cevik  Y .  The effectiveness of greater occipital nerve blockade in treating acute migraine-related headaches in emergency departments.   Acta Neurol Scand. 2018;138(3):212-218. doi:10.1111/ane.12952PubMedGoogle ScholarCrossref
95.
Li  Y , Liang  F , Yang  X ,  et al.  Acupuncture for treating acute attacks of migraine: a randomized controlled trial.   Headache. 2009;49(6):805-816. doi:10.1111/j.1526-4610.2009.01424.xPubMedGoogle ScholarCrossref
96.
Lipton  RB , Dodick  DW , Silberstein  SD ,  et al.  Single-pulse transcranial magnetic stimulation for acute treatment of migraine with aura: a randomised, double-blind, parallel-group, sham-controlled trial.   Lancet Neurol. 2010;9(4):373-380. doi:10.1016/S1474-4422(10)70054-5PubMedGoogle ScholarCrossref
97.
Marcus  SV .  Phase 1 of integrated EMDR: an abortive treatment for migraine headaches.   J EMDR Pract Res. 2008;2(1):15-25. doi:10.1891/1933-3196.2.1.15Google ScholarCrossref
98.
Niazi  M , Hashempur  MH , Taghizadeh  M , Heydari  M , Shariat  A .  Efficacy of topical rose (Rosa damascena Mill.) oil for migraine headache: a randomized double-blinded placebo-controlled cross-over trial.   Complement Ther Med. 2017;34:35-41. doi:10.1016/j.ctim.2017.07.009PubMedGoogle ScholarCrossref
99.
Sasannejad  P , Saeedi  M , Shoeibi  A , Gorji  A , Abbasi  M , Foroughipour  M .  Lavender essential oil in the treatment of migraine headache: a placebo-controlled clinical trial.   Eur Neurol. 2012;67(5):288-291. doi:10.1159/000335249PubMedGoogle ScholarCrossref
100.
Tassorelli  C , Grazzi  L , de Tommaso  M ,  et al; PRESTO Study Group.  Noninvasive vagus nerve stimulation as acute therapy for migraine: the randomized PRESTO study.   Neurology. 2018;91(4):e364-e373. doi:10.1212/WNL.0000000000005857PubMedGoogle ScholarCrossref
101.
Triner  WR , Bartfield  JM , Birdwell  M , Raccio-Robak  N .  Nitrous oxide for the treatment of acute migraine headache.   Am J Emerg Med. 1999;17(3):252-254. doi:10.1016/S0735-6757(99)90118-3PubMedGoogle ScholarCrossref
102.
Wang  L-P , Zhang  X-Z , Guo  J ,  et al.  Efficacy of acupuncture for acute migraine attack: a multicenter single blinded, randomized controlled trial.   Pain Med. 2012;13(5):623-630. doi:10.1111/j.1526-4637.2012.01376.xPubMedGoogle ScholarCrossref
103.
Yang  J , Zeng  F , Feng  Y ,  et al.  A PET-CT study on the specificity of acupoints through acupuncture treatment in migraine patients.   BMC Complement Altern Med. 2012;12:123. doi:10.1186/1472-6882-12-123PubMedGoogle ScholarCrossref
104.
Yarnitsky  D , Dodick  DW , Grosberg  BM ,  et al.  Remote electrical neuromodulation (REN) relieves acute migraine: a randomized, double-blind, placebo-controlled, multicenter trial.   Headache. 2019;59(8):1240-1252. doi:10.1111/head.13551PubMedGoogle ScholarCrossref
105.
Yarnitsky  D , Volokh  L , Ironi  A ,  et al.  Nonpainful remote electrical stimulation alleviates episodic migraine pain.   Neurology. 2017;88(13):1250-1255. doi:10.1212/WNL.0000000000003760PubMedGoogle ScholarCrossref
106.
Zargaran  A , Borhani-Haghighi  A , Salehi-Marzijarani  M ,  et al.  Evaluation of the effect of topical chamomile (Matricaria chamomilla L.) oleogel as pain relief in migraine without aura: a randomized, double-blind, placebo-controlled, crossover study.   Neurol Sci. 2018;39(8):1345-1353. doi:10.1007/s10072-018-3415-1PubMedGoogle ScholarCrossref
107.
Hokenek  NM , Erdogan  MO , Hokenek  UD , Algin  A , Tekyol  D , Seyhan  AU .  Treatment of migraine attacks by transcutaneous electrical nerve stimulation in emergency department: a randomize controlled trial.   Am J Emerg Med. 2021;39:80-85. doi:10.1016/j.ajem.2020.01.024PubMedGoogle ScholarCrossref
108.
Antal  A , Bischoff  R , Stephani  C ,  et al.  Low intensity, transcranial, alternating current stimulation reduces migraine attack burden in a home application set-up: a double-blinded, randomized feasibility study.   Brain Sci. 2020;10(11):21. doi:10.3390/brainsci10110888PubMedGoogle ScholarCrossref
109.
Marmura  MJ , Silberstein  SD , Schwedt  TJ .  The acute treatment of migraine in adults: the American Headache Society evidence assessment of migraine pharmacotherapies.   Headache. 2015;55(1):3-20. doi:10.1111/head.12499PubMedGoogle ScholarCrossref
110.
Lipton  RB , Reed  ML , Kurth  T , Fanning  KM , Buse  DC .  Framingham-based cardiovascular risk estimates among people with episodic migraine in the US population: results from the American Migraine Prevalence and Prevention (AMPP) study.   Headache. 2017;57(10):1507-1521. doi:10.1111/head.13179PubMedGoogle ScholarCrossref
111.
Buse  DC , Reed  ML , Fanning  KM , Kurth  T , Lipton  RB .  Cardiovascular events, conditions, and procedures among people with episodic migraine in the US population: results from the American Migraine Prevalence and Prevention (AMPP) study.   Headache. 2017;57(1):31-44. doi:10.1111/head.12962PubMedGoogle ScholarCrossref
112.
Pringsheim  T , Davenport  WJ , Marmura  MJ , Schwedt  TJ , Silberstein  S .  How to apply the AHS evidence assessment of the acute treatment of migraine in adults to your patient with migraine.   Headache. 2016;56(7):1194-1200. doi:10.1111/head.12870PubMedGoogle ScholarCrossref
113.
Shapiro  RE , Hochstetler  HM , Dennehy  EB ,  et al.  Lasmiditan for acute treatment of migraine in patients with cardiovascular risk factors: post-hoc analysis of pooled results from 2 randomized, double-blind, placebo-controlled, phase 3 trials.   J Headache Pain. 2019;20(1):90. doi:10.1186/s10194-019-1044-6PubMedGoogle ScholarCrossref
114.
Szkutnik-Fiedler  D .  Pharmacokinetics, pharmacodynamics and drug-drug interactions of new anti-migraine drugs: lasmiditan, gepants, and calcitonin-gene-related peptide (CGRP) receptor monoclonal antibodies.   Pharmaceutics. 2020;12(12):E1180. doi:10.3390/pharmaceutics12121180PubMedGoogle Scholar
115.
Pearlman  EM , Wilbraham  D , Dennehy  EB ,  et al.  Effects of lasmiditan on simulated driving performance: results of two randomized, blinded, crossover studies with placebo and active controls.   Hum Psychopharmacol. 2020;35(5):e2732. doi:10.1002/hup.2732PubMedGoogle Scholar
116.
Nir  R-R , Yarnitsky  D .  Conditioned pain modulation.   Curr Opin Support Palliat Care. 2015;9(2):131-137. doi:10.1097/SPC.0000000000000126PubMedGoogle ScholarCrossref
117.
Lipton  RB , Schwedt  TJ , Friedman  BW ,  et al  Demographics, headache characteristics, and other factors associated with opioid use in people with migraine: results from the CaMEO study.   Neurology. 2019;92:S59.006.Google Scholar
118.
Lipton  RB , Araujo  AB , Nicholson  RA ,  et al Patterns of diagnosis, consultation, and treatment of migraine in the US: results of the OVERCOME Study. Presented at: 61st Annual Scientific Meeting of the American Headache Society; July 11-14, 2019; Philadelphia, PA.
119.
Ashina  S , Foster  SA , Nicholson  RA ,  et al Opioid use among people with migraine: results of the OVERCOME study. Presented at: 61st Annual Scientific Meeting of the American Headache Society; July 11-14, 2019; Philadelphia, PA.
120.
Molina  KC , Fairman  KA , Sclar  DA .  Concomitant use of opioid medications with triptans or serotonergic antidepressants in US office-based physician visits.   Drug Healthc Patient Saf. 2018;10:37-43. doi:10.2147/DHPS.S151073PubMedGoogle ScholarCrossref
121.
Bonafede  M , Wilson  K , Xue  F .  Long-term treatment patterns of prophylactic and acute migraine medications and incidence of opioid-related adverse events in patients with migraine.   Cephalalgia. 2019;39(9):1086-1098. doi:10.1177/0333102419835465PubMedGoogle ScholarCrossref
122.
Connelly  M , Glynn  EF , Hoffman  MA , Bickel  J .  Rates and predictors of using opioids in the emergency department to treat migraine in adolescents and young adults.   Pediatr Emerg Care. 2019. doi:10.1097/PEC.0000000000001851PubMedGoogle Scholar
123.
Vinson  DR , Hurtado  TR , Vandenberg  JT , Banwart  L .  Variations among emergency departments in the treatment of benign headache.   Ann Emerg Med. 2003;41(1):90-97. doi:10.1067/mem.2003.24PubMedGoogle ScholarCrossref
124.
Katsarava  Z , Schneeweiss  S , Kurth  T ,  et al.  Incidence and predictors for chronicity of headache in patients with episodic migraine.   Neurology. 2004;62(5):788-790. doi:10.1212/01.WNL.0000113747.18760.D2PubMedGoogle ScholarCrossref
125.
Langemark  M , Olesen  J .  Drug abuse in migraine patients.   Pain. 1984;19(1):81-86. doi:10.1016/0304-3959(84)90067-8PubMedGoogle ScholarCrossref
126.
Salomone  JA  III , Thomas  RW , Althoff  JR , Watson  WA .  An evaluation of the role of the ED in the management of migraine headaches.   Am J Emerg Med. 1994;12(2):134-137. doi:10.1016/0735-6757(94)90231-3PubMedGoogle ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Privacy Policy|Terms of Use
Close
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close

My Saved Courses

You currently have no courses saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close
Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue