• Posted March 20, 2025

Combination Therapy Recommended For Migraines

Doctors should prescribe triptans for migraine patients who aren’t receiving relief from over-the-counter (OTC) pain relievers, according to a new clinical guideline from the American College of Physicians.

The recommendation is based on an evidence review showing that adding a triptan to either a non-steroidal anti-inflammatory drug (NSAID) or acetaminophen worked better to quell migraine pain and headache than OTC products alone, researchers reported in the Annals of Internal Medicine.

This combination therapy “resulted in a higher likelihood of sustained pain relief up to 48 hours after initial treatment and lower likelihood of using rescue medication at 24 hours,” compared with using a triptan alone, said the research team led by Dr. Carolyn Crandall, an internist with the UCLA School of Medicine.

“In addition, combination therapy of a triptan and an NSAID probably results in a higher likelihood of achieving pain relief at 2 hours and sustained pain freedom at 48 hours,” researchers added.

Triptan drugs treat migraines by changing the way blood circulates in the brain, and the way the brain processes pain signals, according to the Cleveland Clinic.

“Using a triptan alone has historically been the first-line treatment of episodic migraine,” reads a summary for patients provided by the ACP.

Episodic migraine occurs when a person has less than 15 headache days a month. By contrast, chronic migraine occurs when an individual has 15 or more headache days a month, notes The American Migraine Foundation.

“Although using a triptan alone is an effective treatment option, ACP found evidence that supports better migraine-related outcomes with the use of a triptan plus a nonsteroidal anti-inflammatory drug or acetaminophen to treat episodic migraine,” the summary says.

These new guidelines mean that doctors should adopt a step-wise approach to managing migraines, according to an accompanying editorial written by Dr. Marianna Shnayderman Yugrakh, a neurologist with the Headache Program at Columbia University Irving Medical Center in New York.

However, Yugrakh said doctors should also think beyond the guidelines to fit treatments to specific patients.

“An individual’s migraine symptoms may warrant specific drugs from a class, and patients whose symptoms vary by attacks may need several different treatments,” Yugrakh wrote.

More information

The Cleveland Clinic has more on triptans for migraines.

SOURCE: American College of Physicians, news release, March 17, 2025