4.7.4.2. Prophylaxis of migraine
National guidance on the pharmacological management of migraine can be found in SIGN 155 (Sept 2022).
Restrictions:
Restricted to use as a second-line prophylatic treatment for migraine.
Prescribing Notes:
Restrictions:
Restricted for use in patients with chronic and episodic migraine who have at least 4 migraine days per month, and who have had prior failure on three or more migraine preventative treatments (local protocol under review).
Restrictions:
Restricted to specialist use only in adults with chronic migraine in accordance with local protocol.
Prescribing Notes:
- Botulinum toxin A (Botox) for chronic migraine should only be used in patients who have failed to respond to ≥4 previous oral prophylactic treatments and where medication overuse has been appropriately managed.
- National guidance on the pharmacological management of migraine can be found in SIGN 155 (Sept 2022).
Restrictions:
Restricted to use as a second-line prophylatic treatment for migraine.
Prescribing Notes:
Restrictions:
Restricted to specialist use in patients with chronic and episodic migraine who have at least 4 migraine days per month, and who have had prior failure on three or more migraine preventative treatments.
Restrictions:
Restricted to specialist use in accordance with local protocol in patients with chronic migraine for whom at least four prior prophylactics have failed and the patient has failed to respond to, or not tolerated, an adequate trial of botulinum toxin A (Botox®). Erenumab may be considered if Botox® is contraindicated.
Restrictions:
Restricted to specialist use in accordance with local protocol for use in patients with chronic migraine for whom at least four prior prophylactic treatment options have failed and the patient has failed to respond to, or has not tolerated an adequate trial of botulinum toxin A or where this is contraindicated.
Restrictions:
Prophylaxis of migraine in adults who have at least 4 migraine days per month is restricted to specialist use for the treatment of patients with chronic and episodic migraine who have had prior failure on three or more migraine preventive treatments. Click here for local protocol.
Restrictions:
For the preventive treatment of episodic migraine in adults who have at least 4 migraine attacks per month, but fewer than 15 headache days per month and who have had prior failure on three or more migraine preventive treatments (local guidance under review).
Prescribing Notes:
Rimegepant is also approved for the treatment for acute migraine - see section 4.7.4.1 for full details.
Prescribing Notes:
- In June 2024, the MHRA advised that topiramate is contraindicated in pregnancy and in women of childbearing potential unless the conditions of a Pregnancy Prevention Programme are fulfilled.
- National guidance on the pharmacological management of migraine can be found in SIGN 155 (Sept 2022).
- Local guidance and referral pathway for migraine is also available here (2021 booklet)