Migraine treatment: Mild to moderate (Formulary: CNS)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Guidelines

Notes: 

  • Soluble simple analgesics (eg paracetamol 1g for mild to moderate migraine, or for all severities of migraine ibuprofen 400mg or soluble aspirin 900mg), if necessary, with an antiemetic, eg metoclopramide 10mg (Drugs used in nausea and vertigo), are often effective if taken early in the attack.
  • Suppositories may be an option.

IBUPROFEN - (First line)

Therapy notes

MHRA advice: Non-steroidal anti-inflammatory drugs (NSAIDs): potential risks following prolonged use after 20 weeks of pregnancy (June 2023) (www.gov.uk).  

  • For OTC use the maximum dose is 1·2 grams daily. 
  • All risks increase above 1·2 grams daily.

Formulation and dosage details

Formulation:

  • Ibuprofen tablets 200mgOTC, 400mgOTC, 600mg

Formulation and dosage details

Formulation:

  • Ibuprofen oral suspension 100mg/5mL

ASPIRIN

Therapy notes

Formulation and dosage details

Formulation:

  • Aspirin dispersible tablets 300mgOTC

Note: There is no proven additional benefit of using aspirin enteric-coated tablets over the dispersible formulation.

Formulation and dosage details

Formulation:

  • Aspirin suppositories 150mgOTC, 300mgOTC

Place in therapy: For patients with swallowing difficulties, consider rectal aspirin administration. 

NAPROXEN

Therapy notes

MHRA advice: Non-steroidal anti-inflammatory drugs (NSAIDs): potential risks following prolonged use after 20 weeks of pregnancy (June 2023) (www.gov.uk). 

Formulation and dosage details

Formulation:

  • Naproxen tablets 250mgOTC, 500mg

Formulation and dosage details

Formulation:

  • Naproxen oral suspension 250mg/5mL

PARACETAMOL

Therapy notes

Check that this content is the same as non-opioid formulary choices

Formulation and dosage details

Formulation:

  • Paracetamol tablets 500mgOTC

Note: Paracetamol caplets may be easier to swallow than standard tablets and are preferred by many patients. Caplets may be supplied on a prescription for paracetamol tablets.

Formulation and dosage details

Formulation:

  • Paracetamol soluble tablets 500mgOTC

Note: The salt content of dispersible formulations of paracetamol may be unsuitable for some patients.

Formulation and dosage details

Formulation:

  • Paracetamol oral suspension 120mg/5mLOTC, 250mg/5mLOTC

Formulation and dosage details

Formulation:

  • Paracetamol suppositories 60mgOTC, 120mgOTC, 240mgOTC, 500mgOTC 

Formulation and dosage details

Formulation:

  • Paracetamol intravenous infusion 500mg/50mL, 1 gram/100mL

MHRA advice: Intravenous paracetamol (Perfalgan▼): risk of accidental overdose (December 2014) 

Notes: 

  • Is 100% bioavailable and there is a greater risk of toxicity so should only be prescribed where clinically indicated. Review the prescription regularly.
  • Should only be used when the patient is ‘nil by mouth’, or has swallowing difficulty that is not overcome by the use of suspension.
  • Must be given in lower doses to patients under 51kg.
  • Renal impairment: increase dose interval as per BNF.
  • Hepatic impairment: reduce dose as per BNF.
  • Increase the minimum interval between each dose to 6 hours if creatinine clearance is less than 30mL/min.
  • Is more effective than paracetamol suppositories.
Consider dose reduction in patients with low body weight (less than 50kg), renal/hepatic impairment, chronic malnutrition, or chronic alcoholism.

Editorial Information

Last reviewed: 30/04/2026

Version: 2

Document Id: F407