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 NICE CG150.
For those who prefer only one drug, consider monotherapy with an oral triptan, NSAID, aspirin (900 mg), or paracetamol NICE CG150.
Start with the lowest-cost triptan and try alternatives if ineffective NICE CG150.
Consider an anti-emetic in addition to other treatments, even if nausea and vomiting are not present NICE CG150.
Do not offer ergots or opioids for acute migraine treatment NICE CG150.
For prophylactic treatment, offer topiramate or propranolol after discussing benefits and risks, including potential adverse effects and the impact on pregnancy NICE CG150.
Consider amitriptyline based on the person's preferences and comorbidities NICE CG150.
Consider acupuncture as an option if other prophylactics are unsuitable or ineffective NICE CG150.
Review the need for continuing prophylaxis after 6 months of treatment NICE CG150.