What leads you to consider prescribing a nasal spray formulation for the treatment of acute migraine?

Interesting discussion. From my perspective, one of the big choices in the acute treatment of migraine is whether to give an oral or non-oral treatment. Patient preference studies show that oral agents are preferred if they work so I usually start there. Most patients prefer nasal sprays to subcutan...

I completely agree with the reasons posted by Dr. @Dr. First Last. I usually agree with my longtime friend, Dr. @Dr. First Last; but I have to say that I disagree with him this time.

Certain nasal sprays work more quickly than comparable tablets, such as Zomig nasal spray, which was my favorite way ...

Major reasons to consider are:

• Faster onset of action.
• Patients with significant nausea/vomiting who cannot tolerate oral.
• Patients with gastroparesis (due to migraine or other causes) lead to poor absorption of oral medications.

I never prescribe nasal sprays for the abortive treatment of migraine because I am not convinced that any of them are more effective than the corresponding tablets (sumatriptan and zolmitriptan) or similar medications in tablet form (gepants).

I have extensive experience with the liquid dihydroergot...

The only thing I would add to this excellent discussion is the elephant in the room: payors and their restrictive policies regarding access. For many providers, the prospect of prior authorizations and peer-to-peer is daunting and prohibitive in small practices. Until we face this challenge head-on,...