Symptomatic treatment of migraine: from scientific evidence to patient management

All migraine patients need symptomatic treatment to stop individual attacks or, at least, significantly relieve pain. When attacks are very frequent (more than 3 days of headache per month on average), they will also need preventive treatment. The first physician the patient must address to for preventive treatment is the general practitioner (GP). If the medication prescribed by the GP is not effective or there is overuse of symptomatic drugs, the patient will have to be referred to a neurologist or a headache clinic. The drugs to be used as symptomatic treatment are triptans and non-steroidal anti-inflammatory drugs. Combination therapy with antiemetics is also important. While specialists will base their therapeutic decisions on guidelines in the literature and on their personal experience, GPs do not yet have any easy-to-use tools to support them. To fill this gap, an algorithm is proposed here that can be easily used by GPs to make decisions during their patients' migraine attacks.