Description: The American College of Physicians (ACP) developed this guideline based on the best available evidence on the comparative benefits and harms of pharmacologic treatments of acute episodic migraine headache, patients’ values and preferences, and economic evidence about these pharmacologic treatments.

Methods: This guideline is based on a systematic review and network meta-analysis of the comparative benefits and harms of pharmacologic treatments of acute episodic migraine headaches, as well as systematic reviews of patients’ values and preferences and comparative cost-effectiveness analyses. The Clinical Guidelines Committee evaluated the following clinical outcomes using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach: pain freedom and pain relief at 2 hours; sustained pain freedom and sustained pain relief up to 48 hours; need for rescue medication within 24 hours; nausea, vomiting, and restored physical function at 2 hours; and overall and serious adverse events (AEs). Additional data on AEs were captured through U.S. Food and Drug Administration medication labels.

Audience and Population: The audience for this clinical guideline is physicians and other clinicians. The population is adults with acute episodic migraine headache (defined as 1 to 14 headache days per month) managed in outpatient settings.

Recommendation 1: ACP recommends that clinicians add a triptan to a nonsteroidal anti-inflammatory drug to treat moderate to severe acute episodic migraine headache in outpatient settings for nonpregnant adults who do not respond adequately to a nonsteroidal antiinflammatory drug (strong recommendation; moderatecertainty evidence).

Recommendation 2: ACP suggests that clinicians add a triptan to acetaminophen to treat moderate to severe acute episodic migraine headache in outpatient settings for nonpregnant adults who do not respond adequately to acetaminophen (conditional recommendation; low-certainty evidence).

美国医师学会（ACP）基于现有最佳证据制定了本指南，内容涉及急性发作性偏头痛药物治疗的获益与风险比较、患者价值观与偏好以及相关药物经济学证据。

方法：本指南基于对急性发作性偏头痛药物治疗获益与风险比较的系统评价与网状Meta分析，同时整合了患者价值观与偏好系统评价及药物经济学比较分析。临床指南委员会采用GRADE（推荐分级的评估、制定与评价）方法对以下临床结局进行评估：2小时无痛率与疼痛缓解率；48小时内持续无痛率与持续疼痛缓解率；24小时内救援药物使用需求；2小时恶心呕吐缓解及躯体功能恢复情况；总体与严重不良事件（AEs）。另通过美国食品药品监督管理局药品标签补充获取不良事件数据。

适用人群与对象：本临床指南面向医师及其他临床工作者，适用对象为门诊管理的急性发作性偏头痛成人患者（定义为每月头痛发作1至14天）。

推荐意见1：对于门诊治疗中对非甾体抗炎药反应不佳的非妊娠成人中重度急性发作性偏头痛患者，ACP建议临床医师在非甾体抗炎药基础上联用曲普坦类药物（强力推荐；中等确定性证据）。

推荐意见2：对于门诊治疗中对对乙酰氨基酚反应不佳的非妊娠成人中重度急性发作性偏头痛患者，ACP建议临床医师考虑在对乙酰氨基酚基础上联用曲普坦类药物（条件性推荐；低确定性证据）。