Quality standard
Quality statement 4: Combined treatment for migraine
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
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
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 different audiences
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.
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 (sometimes called an NSAID) or paracetamol.
Source guidance
Headaches in over 12s: diagnosis and management. NICE guideline CG150 (2012, updated 2021), 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 to 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.