what is the management of migraines?

For the management of migraines, consider offering combination therapy with an oral triptan and an NSAID, or an oral triptan and paracetamol, for acute treatment, taking into account the person's preference, comorbidities, and risk of adverse events. For young people aged 12 to 17 years, consider a nasal triptan in preference to an oral triptan. ¹

If oral or nasal triptans are ineffective or not tolerated, consider a non‑oral preparation of metoclopramide or prochlorperazine, and if used, consider adding a non‑oral NSAID or triptan if they have not been tried. ¹

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

Consider prophylactic treatment if migraines are frequent or severe, discussing options such as topiramate, propranolol, or amitriptyline, with attention to their benefits, risks, and the person's preferences. ¹

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

Advise people that riboflavin (400 mg once daily) may help reduce migraine frequency and intensity for some. ¹