Headache disorders can vary greatly in severity. A causal treatment for primary headache disorders is not currently possible; however, various symptomatic therapies are available. These include preventative and acute treatment of headache attacks. Seven different triptans are currently available as the drugs of choice for the acute treatment of migraine. Non-steroidal anti-inflammatory drugs (NSAIDs), including acetylsalicylic acid and other non-opioid analgesics, are used in the acute treatment of both migraine and tension-type headaches.

Self-medication for headaches is the most common form of acute treatment. Around 91% of migraine patients and 90% of patients with tension-type headaches use painkillers as part of self-medication, often without further treatment or medical advice. Headaches, as a widespread ailment with significant direct and indirect costs, are highly relevant not only for the individual sufferer but also for society and statutory health insurance. Self-medication for migraines and headaches is established worldwide, and satisfaction with treatment using over-the-counter medications is high.

Public access to over-the-counter medications for self-medication is generally described as an important component of the healthcare system, as it allows patients to treat known, episodic symptoms or minor illnesses themselves without having to consult a doctor for a prescription. This therapeutic principle is established in most countries, regardless of how the other provisions for financing the respective healthcare system are formulated.

From a clinical perspective, given the variability in the presentation of migraine and the available treatment options, there is a need for prescription medications, but also room for self-medication. The International Classification of Headache Disorders now distinguishes 48 subtypes of migraine, which differ both qualitatively in terms of their symptoms and quantitatively in terms of severity, frequency, and symptom intensity.

Migraine attacks can occur with high frequency. For example, in chronic migraine, attacks occur on at least 15 days per month. High-frequency attacks, such as those in chronic migraine, attacks with very severe intensities of nausea, vomiting, bed rest, and prolonged pain, sometimes progressing to status migrainosus, require a highly individualized and differentiated approach.

Complex focal neurological symptoms in the context of migraine auras, such as in migraine with brainstem aura, familial hemiplegic migraine, or even in migraine infarction and epileptic seizures triggered by migraine attacks, require thorough medical diagnosis, consultation, and monitoring of the course and success of treatment over time.

Monitoring potential therapy complications, such as medication overuse headache (MOH) with acute medication being taken on at least 10 days or more per month, also requires accompanying medical monitoring of progress and success, as well as therapy adjustment in complex situations.

On the other hand, there are also cases where attacks are infrequent, mild, and short-lived. Complex or multiple neurological symptoms associated with migraine auras are absent. A consistent attack pattern persists for years or even decades, a medical diagnosis has been made, and the affected individuals manage their acute medication effectively. In such cases, preventive medication is generally unnecessary. For these patients, self-medication can significantly improve their care. Direct access to anti-attack medication through self-medication can enable effective attack relief.

For the latter group, self-medication for migraine is an established and proven method of treatment. It is therefore important for these patients that a wide range of therapeutic options are available, allowing for greater choice within the healthcare system. For this reason, it is essential that substances proven effective, but also, and especially, safe, in terms of tolerability and safety, are available for self-medication. Since self-medication targets mild migraine cases that are easy to treat, medications for self-medication should be available in the lower dosage range. The focus should be on the most tolerable and safe therapy possible. This approach was also used in the previous procedures for making naratriptan 2.5 mg, almotriptan 12.5 mg, and sumatriptan 50 mg available without a prescription. These active ingredients are characterized by particularly good tolerability.

Triptans exhibit varying efficacy and tolerability both between and within individuals. Therefore, it is important to make as wide a selection of active ingredients available as possible for the self-medication of migraine attacks. The article in the journal *Pain Medicine* discusses the various aspects of self-medication with triptans.

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