Greater Glasgow and Clyde Medicines
Key to symbols The medicine should be initiated by, or on the advice of a specialist, but is suitable for continuation by a GP The medicine should only be used and prescribed by a specialist Indicates the preferred choice within a class or group of medicines
The medicine should be initiated by, or on the advice of a specialist, but is suitable for continuation by a GP
The medicine should only be used and prescribed by a specialist
Indicates the preferred choice within a class or group of medicines
4.7.4. Antimigraine drugs

4.7.4.1. Treatment of acute migraine

National guidance on the pharmacological management of migraine can be found in SIGN 155 (Sept 2022).

First-line treatment consists of analgesia and (especially if nausea is present) anti-emetics. Second-line treatment with a triptan may be required if first-line treatment is inadequate. All people receiving treatment with a triptan should be followed up where possible.

Preferred List
ASPIRIN (tablets)

Prescribing Notes:

  • 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)

BNF Link

IBUPROFEN (tablets)

Prescribing Notes:

  • 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)

BNF Link

PARACETAMOL (tablets)

Prescribing Notes:

  • 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)

BNF Link

SUMATRIPTAN (TABLETS)

Prescribing Notes:

  • 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)

BNF Link

Total Formulary
FROVATRIPTAN

Prescribing Notes:

  • 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)

BNF Link

RIMEGEPANT (oral lyophilisate)

Restrictions:

Treatment for acute migraine, with or without aura is restricted to use in patients who have had inadequate symptom relief after trials of at least two triptans or in whom triptans are contraindicated or not tolerated; and have inadequate pain relief with non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol.

Prescribing Notes:

Rimegepant has been approved for the preventative management of episodic migraine - see section 4.7.4.2 for full details.

BNF Link

RIZATRIPTAN

Prescribing Notes:

  • Plasma concentrations may be increased by concomitant use of propranolol, therefore the 5mg dose of rizatriptan should be used.
  • Tablets are the preferred oral formulation.
  • 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)

BNF Link

SUMATRIPTAN (ORODISPERSIBLE TABLETS)

Restrictions:

The oro-dispersible tablets are restricted to second line treatment for patients for whom standard tablets are not appropriate.

Prescribing Notes:

  • 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)

BNF Link

SUMATRIPTAN (NASAL SPRAY)

Restrictions:

Sumatriptan nasal spray is restricted to use in patients for whom other formulations are not suitable or effective.

Prescribing Notes:

  • 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)

BNF Link

SUMATRIPTAN (injection)

Restrictions:

Sumatriptan injection is restricted to use in patients for whom other formulations are not suitable or effective.

Prescribing Notes:

  • 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)

BNF Link

ZOLMITRIPTAN

Prescribing Notes:

  • Zolmitriptan nasal spray is non-Formulary.
  • Tablets are the preferred oral formulation.
  • 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)

BNF Link