management of migraine

The management of migraine includes both acute and prophylactic treatments. For acute treatment, offer combination therapy with an oral triptan and an NSAID, or an oral triptan and paracetamol, considering the person's preference and comorbidities ¹.

For those who prefer only one drug, consider monotherapy with an oral triptan, NSAID, aspirin (900 mg), or paracetamol ¹.

Start with the lowest-cost triptan and try alternatives if ineffective ¹.

Consider an anti-emetic in addition to other treatments, even if nausea and vomiting are not present ¹.

Do not offer ergots or opioids for acute migraine treatment ¹.

For prophylactic treatment, offer topiramate or propranolol after discussing benefits and risks, including potential adverse effects and the impact on pregnancy ¹.

Consider amitriptyline based on the person's preferences and comorbidities ¹.

Consider acupuncture as an option if other prophylactics are unsuitable or ineffective ¹.

Review the need for continuing prophylaxis after 6 months of treatment ¹.