Quality statement 4: Combined treatment for migraine

Quality statement

People with migraine are advised to take combination therapy with a triptan and either a non-steroidal anti-inflammatory drug (NSAID) or paracetamol.

Rationale

Correct treatment can relieve the symptoms of migraine and improve quality of life. Previously, people with migraine would have been treated with a stepped-care approach; however, evidence shows that combination therapy with a triptan and either an NSAID or paracetamol is the most effective first-line treatment for migraine.

Quality measures

Structure

Evidence of local arrangements to ensure that people with migraine are advised to take combination therapy with a triptan and either an NSAID or paracetamol.

Data source: Local data collection.

Process

Proportion of people with migraine who are advised to take combination therapy with a triptan and either an NSAID or paracetamol.

Numerator – the number of people in the denominator who are advised to take combination therapy with a triptan and either an NSAID or paracetamol.

Denominator – the number of people with migraine.

Data source: Local data collection.

What the quality statement means for service providers, healthcare practitioners and commissioners

Service providers ensure that systems are in place for people with migraine to be advised to take combination therapy with a triptan and either an NSAID or paracetamol.

Healthcare practitioners advise people with migraine to take combination therapy with a triptan and either an NSAID or paracetamol.

Commissioners ensure that they commission services that advise people with migraine to take combination therapy with a triptan and either an NSAID or paracetamol.

What the quality statement means for patients, service users and carers

People with migraine are advised to take a type of drug called a triptan, to be taken with either a type of drug called a non-steroidal anti-inflammatory drug (or sometimes called an NSAID) or paracetamol.

Source guidance

  • Headaches (NICE clinical guideline 150), recommendation 1.3.10 (key priority for implementation).

Definitions of terms used in this quality statement

Use of triptans For adults an oral triptan should be offered as part of combination therapy. For young people aged 12–17 years a nasal triptan should be considered in preference to an oral triptan.

At the time of publication of the guideline (September 2012), triptans (except nasal sumatriptan) did not have a UK marketing authorisation for this indication in people aged under 18 years. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. The patient (or their parent or carer) should provide informed consent, which should be documented.

NSAIDs, paracetamol and some triptans are available over the counter at pharmacies and therefore may not always require a prescription.

Equality and diversity considerations

To ensure treatment is effective it should take into account the person's age, preference, comorbidities and risk of adverse events.