Doctors should consider prescribing triptans to migraine patients who don’t get enough relief from common over-the-counter (OTC) pain relievers, according to new clinical guidelines from the American College of Physicians (ACP).
This advice is based on strong evidence that combining triptans with OTC drugs such as NSAIDs (like ibuprofen) or acetaminophen works better than using OTC medications alone.
The guideline, published in the Annals of Internal Medicine, suggests that patients who take a triptan with an NSAID or acetaminophen are more likely to experience lasting pain relief for up to 48 hours. They’re also less likely to need a second round of medication within 24 hours of the first treatment.
Dr. Carolyn Crandall of UCLA, who led the research, explained that this combination approach not only improved short-term pain relief at the two-hour mark, but also gave patients a better chance of being free from migraine pain for longer. The benefits were stronger than using a triptan by itself.
Triptans are a class of drugs that work by changing how blood flows in the brain and by altering the way the brain perceives pain. They have been used for years as a first-line treatment for episodic migraine, which is defined as fewer than 15 headache days per month. In contrast, chronic migraine occurs when someone has headaches on 15 or more days a month.
While triptans alone have been effective, the ACP’s updated guidance reflects recent studies that show patients do even better when triptans are combined with common painkillers. This combo appears to increase the chances of meaningful and longer-lasting pain relief.
The updated guideline recommends a step-wise approach to treating migraines—starting with OTC medications and moving to triptans or combination therapy if those aren’t effective.
In an editorial that accompanied the guideline, Dr. Marianna Shnayderman Yugrakh of Columbia University emphasized that while following treatment steps is helpful, it’s also important to tailor care to each patient’s needs. People experience migraines differently, and some may need specific drugs or multiple treatment options depending on how their symptoms change from one migraine to the next.
This new recommendation offers a clearer pathway for doctors and patients frustrated by migraines that don’t respond well to OTC options. For people who often suffer from debilitating headaches, the evidence supports trying a combination of triptans and pain relievers to improve relief and reduce the need for additional medication later on.
Overall, this guidance could help many migraine sufferers gain better control over their symptoms—and with fewer disruptions to daily life. However, as with all medications, triptans may not be suitable for everyone and should only be used under a doctor’s supervision, especially for people with certain heart or vascular conditions.
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The research findings can be found in Annals of Internal Medicine.
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