Headache disorders can vary in severity. A causal treatment of the primary forms of headache is currently not possible, but various symptomatic therapies are available. These include preventative and acute treatment of headache attacks. Today, seven different triptans are available as the drug of choice for the acute treatment of migraines. Nonsteroidal anti-inflammatory drugs (NSAIDs) including acetylsalicylic acid and other non-opioid analgesics are used in the acute treatment of both migraine and tension-type headache.

Self-medication of 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. As a widespread disease with serious direct and indirect costs, headaches are highly relevant not only for the individual affected, but also for society and statutory health insurance. Self-medication for migraines and headaches is established worldwide and satisfaction with treatment with non-prescription medicines is high.

Public access to non-prescription medicines through self-medication is widely described as an important part of the healthcare system, as it enables patients to self-treat known episodic complaints or minor illnesses 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 severity of migraines and the available treatment options, there is a need for prescription drugs, but there is also room for self-medication. The International Headache Classification now distinguishes between 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. In chronic migraine, migraine attacks occur on at least 15 days a month. High-frequency attacks such as those in chronic migraines, attacks with very severe intensities ranging from nausea, vomiting, bed rest and long bouts of pain to status migraenosus require a very individual, differential approach.

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

The monitoring of possible therapy complications such as medication overuse headache (MÜK) with the frequency of taking acute medication on at least 10 days or more per month also requires accompanying medical progress and success monitoring as well as therapy adjustment in complex situations.

On the other hand, there are also courses in which the attacks only occur infrequently, lightly and for a short duration. There are no complex or multiple neurological symptoms associated with migraine headaches. A consistent attack phenomenology exists over years or even decades, a medical diagnosis has been made and there is a competent, individual handling of the acute medication by those affected. In such cases, preventive medication is usually not necessary. For these affected people, self-medication can contribute to a significant improvement in care. Immediate access to attack medication as part of self-medication can enable effective cessation of attacks.

For the latter group, self-medication of migraines is established and proven in the care process. For these affected people, it is therefore important that the most diverse therapy options possible are available, which enable a greater choice of care options. For this reason, the aim is to ensure that substances that have proven themselves in terms of their effectiveness, but also particularly in terms of their tolerability and safety, are available for self-medication. Since self-medication is aimed at mild migraines that are easy to treat, medications for self-medication should be made available in the lower dosage range. The focus should be on therapy that is as tolerable and safe as possible. The previous procedures for dispensing with the prescription requirement for Naratriptan 2.5 mg, Almotriptan 12.5 mg and Sumatriptan 50 mg were carried out accordingly. These active ingredients are characterized by particularly good tolerability.

Triptans have varying effectiveness and tolerability between and within individuals. It is therefore important that as wide a selection of active ingredients as possible be made available for 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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