Update information

Recommendations on the prophylactic treatment of migraine were updated or added in 2015.

These are marked as:

  • [new 2015] if the evidence has been reviewed and the recommendation has been added or updated

  • [2015] if the evidence has been reviewed but no change has been made to the recommended action.

Where recommendations end [2012], the evidence has not been reviewed since the original guideline.

Where recommendations end [2012, amended 2015], the evidence has not been reviewed but changes have been made to the recommendation wording that change the meaning (for example, because of equalities duties or a change in the availability of medicines, or incorporated guidance has been updated). Explanations of the reasons for the changes are given in 'Amended recommendation wording (change to meaning)' for information.

Amended recommendation wording (change to meaning)

Recommendation in 2012 guideline

Recommendation in 2015 guideline

Reason for change

1.3.18 If both topiramate[a] and propranolol are unsuitable or ineffective, consider a course of up to 10 sessions of acupuncture over 5–8 weeks or gabapentin[b](up to 1200 mg per day) according to the person's preference, comorbidities and risk of adverse events.

1.3.18 Consider amitriptyline[c] for the prophylactic treatment of migraine according to the person's preference, comorbidities and risk of adverse events. [new 2015]

1.3.19 Do not offer gabapentin for the prophylactic treatment of migraine. [new 2015]

The evidence for prophylaxis has been reviewed.

1.3.20 If both topiramate and propranolol[d] are unsuitable or ineffective, consider a course of up to 10 sessions of acupuncture over 5–8 weeks according to the person's preference, comorbidities and risk of adverse events. [2012, amended 2015]

The updated evidence review did not look at acupuncture so this part of the recommendation is unchanged and the use of gabapentin has been removed.

1.3.19 For people who are already having treatment with another form of prophylaxis such as amitriptyline, and whose migraine is well controlled, continue the current treatment as required.

1.3.21 For people who are already having treatment with another form of prophylaxis and whose migraine is well controlled, continue the current treatment as required. [2012, amended 2015]

The words 'such as amitriptyline' have been removed because this is now included in recommendation 1.3.18.

[a] At the time of publication (September 2012), topiramate did not have a UK marketing authorisation for this indication in people aged under 18 years. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. The patient (or their parent or carer) should provide informed consent, which should be documented. See the General Medical Council's Good practice in prescribing medicines – guidance for doctors and the prescribing advice provided by the Joint Standing Committee on Medicines (a joint committee of the Royal College of Paediatrics and Child Health and the Neonatal and Paediatric Pharmacists Group) for further information.

[b] At the time of publication (September 2012), gabapentin did not have a UK marketing authorisation for this indication. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. The patient (or their parent or carer) should provide informed consent, which should be documented. See the General Medical Council's Good practice in prescribing medicines – guidance for doctors and the prescribing advice provided by the Joint Standing Committee on Medicines (a joint committee of the Royal College of Paediatrics and Child Health and the Neonatal and Paediatric Pharmacists Group) for further information.

[c] At the time of publication (November 2015), amitriptyline did not have a UK marketing authorisation for this indication. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the General Medical Council's Prescribing guidance: prescribing unlicensed medicines for further information.

[d] At the time of publication (November 2015), topiramate did not have a UK marketing authorisation for use in children and young people for this indication. Propranolol did not have a UK marketing authorisation for use in children under 12 years for this indication. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the General Medical Council's Prescribing guidance: prescribing unlicensed medicines for further information.

ISBN: 978-1-4731-1533-0

  • National Institute for Health and Care Excellence (NICE)