What to do if NSAIDs/analgesics fail in Migraine Management?

It becomes difficult to decide what to do if a particular regimen of treatment of migraine fails. Here are some of the clinical situations when one regimen of migraine management fails and what to do after it fails:

What to do if common analgesics and commonly used non steroidal anti inflammatory drugs fails in managing migraine?

In mild to moderate migraine attacks, generally NSAIDs/analgesics are used as first line of management. If commonly used non steroidal anti inflammatory drugs and analgesics like aspirin or paracetamol fails, than there are a few treatment/management options available to a patient with migraine headache and the options are given here:

First tier management of failed NSAIDs/analgesics in migraine:

The first line of management or the first tier of managing a patient with failed NSAIDs/analgesics is to use any one of the triptan drugs like sumatriptan (at the dose of 50 mg or 100 mg orally), almotriptan (at the dose of 12.5 mg orally), rizatriptan (at the dose of 10 mg orally), eletriptan (at the dose of 40 mg orally), zolmitriptan (at the dose of 2.5 mg orally). The efficacy of these drugs is almost same in treatment of migraine and any one of the above mentioned triptans can be used. The triptan which suits best for an individual should be used.

The second option:

The second option of management of migraine headache, if NSAIDs/analgesics have failed to manage migraine is generally slower to effect but has better tolerability to the regimen. Triptans like naratriptan (at the dose of 2.5 mg orally) and frovatriptan (at the dose of 2.5 mg orally) are used in second option of treatment.

The third option:

The third option is for the patients of migraine with infrequent attacks and failed NSAIDs/analgesic management. For infrequent attacks of migraine headache and failed NSAIDs/analgesics, dihydroergotamine nasal spray 2 mg or ergotamine at the dose of 1 to 2 mg orally is used commonly.