Pharmacological management of migraine

Migraine is the most common severe form of primary headache with a global prevalence of around one in seven people. It is the most common underlying headache disorder in patients with medication overuse headache.

Remit and target users

This guideline provides recommendations on the pharmacological management of adults with acute migraine, and prophylaxis for patients with episodic or chronic migraine or medication overuse headache.

This guideline will be of interest to healthcare professionals in primary and secondary care, including general practitioners, headache nurses, neurologists, pharmacists, and patients with migraine.

How this guideline was developed

This guideline was developed using a standard methodology based on a systematic review of the evidence. Further details can be found in SIGN 50: A Guideline Developer’s Handbook.

Keeping up to date

This guideline was published in 2018. Following a scoping review three years after publication, the guideline was updated in 2022 and 2023 to include new recommendations on CGRP monoclonal antibodies (section 4.14), and new safety advice on the use of therapies during pregnancy.

In June 2024 the MHRA issued new safety measures for the use of topiramate during pregnancy due to risks to the unborn child:

Topiramate should not be used in women of childbearing potential unless the conditions of the Pregnancy Prevention Programme are fulfilled. This aims to ensure that all women of childbearing potential:

• are using highly effective contraception
• have a pregnancy test to exclude pregnancy before starting topiramate
• are aware of the risks from use of topiramate.

Further information is available: Topiramate (Topamax): introduction of new safety measures, including a Pregnancy Prevention Programme

The guideline is under review to take account of this advice.

The review history is noted in the update report.

​ Current < 3 years