Based on a systematic review and network meta-analysis commissioned by the American College of Physicians (ACP), the ACP published guidelines for outpatient management of acute episodic migraine in non-pregnant and non-lactating adults, taking into account evidence of comparative benefits and risks of available medication options as well as patient preferences.

They advise that patients with inadequate pain relief using NSAIDs or paracetamol can first try increasing the dose of these medicines up to the maximum daily recommended dose.

For those with an inadequate response, the next step would be to try treating a subsequent migraine with a combination of a triptan and NSAIDs (or paracetamol if NSAIDs contraindicated or not tolerated).

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