4.6.2a Migraine
Please see NHS Kent and Medway CCG Management of Adults with Headaches and Migraines in Primary Care, for other drugs used in the prophylaxis and treatment of migraine and headache here.
Please see Rimegepant for acute treatment of migraine – Guideline for Primary Care here.
|
Rimegepant (acute) |
Rimegepant (preventative) |
Atogepant (preventative) |
|
|
STOP if less than 50% reduction in headache days. |
STOP if less than 50% reduction in headache days. |
12 weeks initial treatment. |
|
|
Formulary status
|
Primary care/GP initiation, prescribing and monitoring
|
Secondary care/Community Specialist initiation and continuation |
(pending for atogepant) |
|
Chronic Migraine (Prophylaxis (15 or more headache days a month, 8 with migraine symptoms)) |
No |
No |
Yes |
|
Episodic Migraine - High frequency (Prophylaxis - more than 4 and fewer than 15 headache days a month) |
N/A |
Yes |
Yes |
|
Acute migraine rescue |
Yes (Triptans contraindicated and NSAIDs and paracetamol tried but ineffective) |
N/A |
No |
|
Secondary care/Community Specialist initiation |
Yes |
Yes |
Yes |
|
GP initiation |
Yes |
No |
Pending |
|
Secondary care/Community Specialist monitoring |
Yes |
Yes |
Pending |
|
GP monitoring |
Yes |
No |
Pending |
|
Blueteq availability* (GP surgery/primary care) |
No |
No |
No |
|
Blueteq availability* (secondary care/community specialist providers) |
No |
Yes |
Yes |
|
ICB approved to use |
Yes |
Yes |
Pending (approved use currently in secondary care only) |
|
Homecare availability in GP surgery/primary care |
No |
No |
No |
|
Homecare availability (secondary care/community specialist providers) |
No |
Yes |
Yes |
Further work is currently being undertaken on this and the information will be updated accordingly in due course.
Expand All / Expand All (incl. cost)
| Pack | Price |
|---|---|
| 12 tablet | |
| 2 tablet | |
| 4 tablet | |
| 6 tablet | £0.92 |
| Pack | Price |
|---|---|
| 12 tablet | |
| 2 tablet | |
| 4 tablet | |
| 6 tablet | £1.20 |
| Pack | Price |
|---|---|
| 2 unit dose | £14.16 |
| Pack | Price |
|---|---|
| 2 unit dose | |
| 6 unit dose | £42.47 |
| Pack | Price |
|---|---|
| 2 pre-filled disposable injection | £48.49 |
| 6 pre-filled disposable injection |
| Pack | Price |
|---|---|
| 2 pre-filled disposable injection | £48.19 |
| Pack | Price |
|---|---|
| 2 pre-filled disposable injection | £50.96 |
Frovatriptan is recommended as an option in menstrual migraine prophylaxis See local guidance here.
| Pack | Price |
|---|---|
| 6 tablet | £20.03 |
5mg is usually only required when renal or hepatic insufficiency or when used in conjunction with propranolol. It is significantly higher cost than 10mg
| Pack | Price |
|---|---|
| 3 tablet | |
| 6 tablet | £32.55 |
| Pack | Price |
|---|---|
| 12 tablet | |
| 2 tablet | |
| 3 tablet | £4.96 |
| 6 tablet |
| Pack | Price |
|---|---|
| 3 tablet | £6.31 |
| 6 tablet |
Prescribe as generic orodispersable tablets. These can be taken in exactly the same way as lyophillasites/melts and effectiveness and speed of use will not
be affected.
| Pack | Price |
|---|---|
| 12 tablet | £53.48 |
| 2 tablet | |
| 3 tablet | £13.37 |
| 6 tablet | £26.74 |
| Pack | Price |
|---|---|
| 12 tablet | £28.86 |
| 6 tablet | £14.43 |
| Pack | Price |
|---|---|
| 6 tablet | £17.68 |
Significantly higher cost than immediate release tablets. Does not increase rate of absorption
| Pack | Price |
|---|---|
| 6 tablet | £19.06 |
| Pack | Price |
|---|---|
| 6 unit dose | £36.50 |
Documents
-
Primary Care
-
Secondary Care
-
Primary and Secondary Care
Management of Adults with Headaches and Migraines in Primary Care - 2.1
Uploaded By:
Renewal: 10/2022
Approved: 10/2022
Last Reviewed: 10/2022
Caution: This document is due for renewal and may be out of date
Document linked to:
| Drug | Section |
|---|---|
| Botulinum A toxin |
4.6.2a Migraine
|
| Erenumab |
4.6.2a Migraine
|
| Fremanezumab |
4.6.2a Migraine
|
| Galcanezumab |
4.6.2a Migraine
|
Specialist prescribing only when used in accordance with NICE TA 871.
| Pack | Price |
|---|---|
| 1 vial |
Documents
-
Primary Care
-
Secondary Care
-
Primary and Secondary Care
Management of Adults with Headaches and Migraines in Primary Care - 2.1
Uploaded By:
Renewal: 10/2022
Approved: 10/2022
Last Reviewed: 10/2022
Caution: This document is due for renewal and may be out of date
Document linked to:
| Drug | Section |
|---|---|
| Botulinum A toxin |
4.6.2a Migraine
|
| Erenumab |
4.6.2a Migraine
|
| Fremanezumab |
4.6.2a Migraine
|
| Galcanezumab |
4.6.2a Migraine
|
Documents
-
Primary Care
-
Secondary Care
-
Primary and Secondary Care
Management of Adults with Headaches and Migraines in Primary Care - 2.1
Uploaded By:
Renewal: 10/2022
Approved: 10/2022
Last Reviewed: 10/2022
Caution: This document is due for renewal and may be out of date
Document linked to:
| Drug | Section |
|---|---|
| Botulinum A toxin |
4.6.2a Migraine
|
| Erenumab |
4.6.2a Migraine
|
| Fremanezumab |
4.6.2a Migraine
|
| Galcanezumab |
4.6.2a Migraine
|
Documents
-
Primary Care
-
Secondary Care
-
Primary and Secondary Care
Management of Adults with Headaches and Migraines in Primary Care - 2.1
Uploaded By:
Renewal: 10/2022
Approved: 10/2022
Last Reviewed: 10/2022
Caution: This document is due for renewal and may be out of date
Document linked to:
| Drug | Section |
|---|---|
| Botulinum A toxin |
4.6.2a Migraine
|
| Erenumab |
4.6.2a Migraine
|
| Fremanezumab |
4.6.2a Migraine
|
| Galcanezumab |
4.6.2a Migraine
|
Documents
-
Primary Care
-
Secondary Care
-
Primary and Secondary Care
Primary Care Prescribing Guideline For Rimegepant
Uploaded By:
Renewal: 06/2026
Approved: 06/2024
Last Reviewed: 06/2024
Document linked to:
| Drug | Section |
|---|---|
| Rimegepant (migraine treatment) |
4.6.2a Migraine
|
Rimegepant (Vydura®) is indicated for the acute treatment of migraine with or without aura in adults. To be used in accordance with NICE TA919. NHS Kent and Medway have produced this guidance to support with the implementation and prescribing of rimegepant for the treatment of acute migraines. Locally, this treatment will be used in patients who have a confirmed diagnosis of episodic migraine with an acute exacerbation of migraine symptoms. See Primary Care Prescribing Guideline for Rimegepant here.
| Pack | Price |
|---|---|
| 2 tablet | £25.80 |
| 8 tablet | £103.20 |
Specialist prescribing only for preventing migraine in adults when used in accordance with NICE TA 906. Requires referral to specialist migraine service.
| Pack | Price |
|---|---|
| 2 tablet | £25.80 |
| 8 tablet | £103.20 |
| Pack | Price |
|---|---|
| 6 tablet | £22.50 |
| Pack | Price |
|---|---|
| 6 tablet | £22.50 |
NICE do not recommend opioids for migraine treatment; https://cks.nice.org.uk/migraine#!scenario
| Pack | Price |
|---|---|
| 1 tablet | |
| 30 tablet |
| Pack | Price |
|---|---|
| 30 suppository |
| Pack | Price |
|---|---|
| 16 tablet | |
| 24 tablet | £6.25 |
| 4 tablet | |
| 8 tablet |
| Pack | Price |
|---|---|
| 12 tablet | £5.00 |
| 16 tablet | |
| 24 tablet | £7.95 |
| 32 tablet | |
| 48 tablet | £3.97 |
| 8 tablet |
NICE do not recommend opioids for migraine tx https://cks.nice.org.uk/migraine#!scenario
| Pack | Price |
|---|---|
| 12 tablet (1 x (8 tablets + 4 tablets)) | £5.45 |
| 24 tablet (1 x (2 x(8 tablets+4 tablets))) | £8.46 |
| 48 tablet (1 x(4 x (8 tablets+4 tablets))) | £3.43 |