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Table 3 Use of simple analgesics, NSAIDs, triptans or combinations for the symptomatic treatment of migraine

From: Consensus of the Hellenic Headache Society on the diagnosis and treatment of migraine

• For decision-making physicians should take into account the patients’ preferences, life-style particularities and personal expectancies.
• In patients with mild migraines we suggest using aspirin or paracetamol 1 g, per os, for the symptomatic treatment of migraine.
• In patients with migraine who have failed to aspirin or paracetamol 1 g, or who cannot use these agents because of comorbidities, adverse events or poor tolerability, or their migraines have mild to severe intensity, we suggest using triptans per os, or non-steroidal anti-inflammatory drugs (NSAIDs), or combinations, according to their potential comorbidity and tolerance to these drugs.
• If migraines recur after successful symptomatic treatment, the use of long acting triptans may be useful (e.g. almotriptan, naratriptan and fravotriptan).
• If migraines do not respond to oral high efficacy triptans (e.g. eletriptan 40 or 80 mg, or rizatriptan 10 mg) a combination of a triptan with NSAID, sumatriptan 50 mg or 100 mg with naproxen 500 mg in particular, is recommended.
• Not all triptans share the same efficacy, safety and pharmacokinetics within an individual, thus no response to one triptan does not predict unresponsiveness to all triptans.
• Consistency of triptans and other symptomatic drugs for migraine is limited and may vary by individual; therefore, rescue medication should be offered to all patients for symptomatic treatment of migraine; this should be parenterally given to avoid potential gastric stasis, e.g. sumatriptan subcutaneously, or NSAID suppositories.
• All migraineurs should be educated by their treating physicians to limit the use of symptomatic anti-migraine drugs to a maximum of two days per week if they use triptans, or combinations of drugs, or three days per week if they use NSAIDs or simple analgesics, in order to avoid medication overuse headache (since the related ICHD-3 limits are 10 and 15 days/month [11], by this suggestion we prevent from medication overuse securely).
• All migraineurs should be educated by their treating physicians that the symptomatic treatment of migraine is only a small part of the management of migraine, that requires additional prophylactic pharmacotherapy in most cases, life-style changes and non-pharmaceutical approaches depending on the particular patient and the potential comorbidity.