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 2025), recommendation 1.3.10
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.
In June 2025, this was an off-label use of triptans (except nasal sumatriptan) in under 18s. See NICE's information on prescribing medicines.
NSAIDs, paracetamol and some triptans
These 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.