In this section "SPECIALISTS" refer to medical prescribers specialising in Mental Health unless otherwise stated. At Guy's and St Thomas' and Lewisham Hospitals this would refer to SLAM employed consultants
Treatment of the acute migraine attack
Paracetamol tabs, soluble tabs
Joint Formulary Committee approved off-label use (specialist headache clinic use only):
Short-lasting Unilateral Neuralgiform Headache attacks with conjunctival injection and Tearing (SUNCT)
Short-lasting Unilateral Neuralgiform Headache attacks with Cranial Autonomic Symptoms (SUNA) See dosing protocol from KCH for further information
SPECIALIST USE ONLY Inpatient management of severe withdrawal headache Dose = 1g once to three times daily for up to 4 days
SPECIALIST USE ONLY For the diagnosis of indometacin sensitive headaches (paroxysmal hemicranias) Dose = 100-200mg intramuscular test dose
Sumatriptan tabs, injection
SPECIALIST USE ONLY Inpatient treatment of medical refractory disabling migraine and cluster headaches.
See dosing protocol from KCH for further information
Maximum daily dose of 30mg for a maximum of 5 days. See MHRA davice.
Specialist Prescribing only.
The responsibility for prescribing, monitoring, dose adjustment and review should remain with the specialist.
In very exceptional circumstances a specialist may discuss individual patient need for a RED drug to be prescribed by a GP and the GP should consider informing the Medicines Management team before a decision is made to prescribe for individual patients.
Treatment can be initiated in primary care after a recommendation from an appropriate specialist
Specialist initiation followed by maintenance prescribing in primary care
Specialist initiation with ongoing monitoring required. After dose stabilisation GPs can be requested to take over prescribing responsibilities using the approved APC shared care documentation