The National Institute for Health and Care Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on transcranial magnetic stimulation for treating and preventing migraine, in January 2014.
Migraine is a common condition characterised by recurrent, pulsatile, unilateral or bilateral headaches that can last for hours to days and are often accompanied by nausea, and sensitivity to light and sound. Migraine headache may be preceded by an aura, which can include visual or olfactory disturbances, or difficulties with speech (dysphasia). The second edition of International Classification of Headache Disorders (International Headache Society 2004) provides a classification of migraine types.
Current treatment for migraine aims to prevent or stop episodes and manage symptoms with drugs such as triptans, analgesics and anti-emetics (as recommended in headaches: diagnosis and management of headaches in young people and adults [NICE guideline CG150]). Other treatments include nerve blocks, botulinum toxin type A injections (as recommended in botulinum toxin type A for the prevention of headaches in adults with chronic migraine [NICE technology appraisal guidance 260]) or acupuncture.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.