Headache service formulary mmc approved dec201

Headache Service Formulary v1.0
Drug Name & Dose Range
1st Line Treatment
2nd Line Treatment
3rd Line Treatment
Comments

Migraine Acute Treatments
Simple analgesia♣ and
lyophilisates 10mg or Zolmitriptan nasal spray In very severe migraines: Sumatriptan s/c injection 12mg/ml 0.5ml syringe ONLY when oral medication not possible due to vomiting AND Zolmitriptan nasal spray not tolerated
Migraine Prevention
All preventative treatments initially start as monotherapy. If side effects to first drug or not response at all then change to second line
drug. If some benefit with initial drug but not completely resolved then dual therapy with a second line drug may be appropriate.
The choice of preventative medication should be guided by the side effect profile and the patient’s comorbid conditions.
Propranolol 80mg-240mg Amitripyline∇ 10mg-
Following are third line use options with stated Sodium Valporate∇ 400mg-1,500mg daily in divided doses in if bipolar disorder coexists Venlafaxine∇ 75mg- 150mg if depression Gabapentin∇ 300mg daily initially increasing according to response upto 2400mg daily in three divided doses if neuropathic pain/ muscle ♣ Simple analgesia: Ibuprofen 400mg 4-6 hourly prn or Paracetamol 1000mg 4-6 hourly prn or Aspirin 600-900mg dispersible 4-6 hourly prn or Naproxen∇ 500mg-1000mg bd ♦ Antiemetics: Metoclopramide 10mg tds or Prochlorperazine 10mg 2-3 times daily PRN or Domperidone 10-20mg 3-4 times daily ∇ Unlicensed indication Headache Service Formulary MMC Approved Dec 2011

Chronic Tension Type Headaches Acute Treatments

Chronic Tension Type Headaches Prevention
All preventative treatments initially start as monotherapy. If side effects to first drug or not response at all then change to second line
drug. If some benefit with initial drug but not completely resolved then dual therapy with a second line drug may be appropriate.
The choice of preventative medication should be guided by the side effect profile and the patient’s comorbid conditions.
Stop overuse of

Cluster Headaches Acute Treatments
Zolmitriptan∇ nasal spray 5mg/0.1ml used if Prednisolone∇ 60-100mg once daily for 2-5 days can be used if preventative therapy starting. NB: dose reduction to occur after 2-5days in 10mg
Cluster Headaches Prevention
All preventative treatments initially start as monotherapy. If side effects to first drug or not response at all then change to second line
drug. If some benefit with initial drug but not completely resolved then dual therapy with a second line drug may be appropriate.
The choice of preventative medication should be guided by the side effect profile and the patient’s comorbid conditions.
ECG needed if doses more than 480mg daily Headache Service Formulary MMC Approved Dec 2011
Paroxysmal Hemicrania/ Hemicrania continua
Indometacin∇ upto
References
Scottish Intercollegiate Guideline Network. National Clinical Guideline 107. Diagnosis and Management of Headaches in Adults. Nov 2008
British Association for the Study of Headache. Guidelines for All Healthcare Professionals in the Diagnosis and Management of Migraine, Tension-Type
Headache, Cluster Headache and Medication-Overuse Headache. 3rd edition 2010.

Date Developed: November 2011
Date Ratified by NHS Lambeth Medicines Management Committee: December 2011
Date of Review: June 2012
Headache Service Formulary MMC Approved Dec 2011

Source: http://lpbcc.files.wordpress.com/2010/06/headache-service-formulary-mmc-approved-dec2011.pdf