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.
Restrictions:
Migraleve yellow® is excluded as it is equivalent to co-codamol 8/500, but much more expensive.
Prescribing Notes:
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.
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)
Restrictions:
The oro-dispersible tablets are restricted to second line treatment for patients for whom standard tablets are not appropriate.
Prescribing Notes:
Restrictions:
Sumatriptan nasal spray is restricted to use in patients for whom other formulations are not suitable or effective.
Prescribing Notes:
Restrictions:
Sumatriptan injection is restricted to use in patients for whom other formulations are not suitable or effective.
Prescribing Notes: