4.7.4 Antimigraine drugs

5HT1 receptor agonists

Sumatriptan
  • Tablet 50mg, 100mg (£0.64 = per tablet 100mg)
  • Injection 6mg/0.5ml syringe (£45.00 = pack 2 generic pre-filled syringes)
  • Injection 3mg/0.5ml syringe (£39.50 = pack 2 pre-filled syringes) (see note 2 below)
  • Nasal spray 10mg/0.1ml actuation, 20mg/0.1ml actuation (£42.47 = 20mg pack 6 unit doses)

Indications

Dose

  • Oral: migraine. Dose: 50mg (some patients may require 100mg); the dose may be repeated after at least 2 hours if migraine recurs; maximum 300mg in 24 hours
  • Subcutaneous 6mg injection: cluster headache or migraine. Dose: a single 6mg injection; the dose may be repeated once after at least 1 hour if headache recurs; maximum 12mg in 24 hours
  • Subcutaneous 3mg injection: migraine if sumatriptan 6mg injection is effective, but not tolerated. Dose: a single 3mg injection; the dose may be repeated once after at least 1 hour if headache recurs; maximum 6mg in 24 hours (see note 2 below)
  • Intranasally: cluster headache [unlicensed] or migraine. Dose: 10–20mg into one nostril; the dose may be repeated once after at least 2 hours if headache recurs. Maximum in 24 hours: two 10mg doses or two 20mg doses

Notes

  1. Sumatriptan nasal spray is licensed for use in children aged 12 to 18 years of age
  2. Sumatriptan 3mg subcutaneous injection is included in the formulary for the treatment of migraine only. There is very limited evidence comparing sumatriptan 3mg and 6mg subcutaneous injection. If sumatriptan 6mg subcutaneous injection is effective but not tolerated, consider reducing the dose to the 3mg injection. If a patient consistently uses more doses of sumatriptan 3mg injection than the 6mg injection, prescribing of the 3mg injection should be reconsidered.
  3. All prescriptions for sumatriptan should be written generically.
Almotriptan
  • Tablet 12.5mg (£2.78 = per tablet)

Indications

Dose

  • 12.5mg as soon as possible after onset repeated after 2 hours if migraine recurs (patient not responding should not take second dose for same attack); maximum 25mg in 24 hours
Frovatriptan
  • Tablet 2.5mg (£1.07 = per tablet)

Indications

Dose

  • 2.5mg as soon as possible after onset repeated after 2 hours if migraine recurs (patient not responding should not take second dose for same attack); maximum 5mg in 24 hours

Notes

  1. Frovatriptan has been included because it has a much longer half-life than other agents and the effects may last for longer.

Prophylaxis of migraine

Drugs used for prophylaxis of migraine not listed below:

Refer also to Prophylaxis of migraine guidance

Erenumab
  • Solution for injection pre-filled pens 70mg/1ml, 140mg/1ml

Notes

  1. NICE TA682: Erenumab (Aimovig) is recommended as an option for preventing migraine in adults (March 2021), only if:
    1. they have 4 or more migraine days a month
    2. at least 3 preventive drug treatments have failed
    3. the 140mg dose of erenumab is used and
    4. the company provides it according to the commercial arrangement
  2. Stop erenumab after 12 weeks of treatment if:
    1. in episodic migraine (less than 15 headache days a month) the frequency does not reduce by at least 50%
    2. in chronic migraine (15 headache days a month or more with at least 8 of those having features of migraine) the frequency does not reduce by at least 30%
  3. The preferred option in Devon for the treatment of patients with chronic migraine who have failed on at least 3 preventative drug treatments is Botulinum Toxin Type A (Botox®) (see 4.9.3 Drugs used in essential tremor, chorea, tics, and related disorders)
Fremanezumab
  • Solution for injection pre-filled pens 225mg/1.5ml

Notes

  1. NICE TA631: Fremanezumab (Ajovy) is recommended as an option for preventing migraine in adults (June 2020), only if:
    1. the migraine is chronic, that is, 15 or more headache days a month for more than 3 months with at least 8 of those having features of migraine
    2. at least 3 preventive drug treatments have failed and
    3. the company provides it according to the commercial arrangement
  2. Stop fremanezumab if the migraine frequency does not reduce by at least 30% after 12 weeks of treatment
  3. The preferred option in Devon for the treatment of patients with chronic migraine who have failed on at least 3 preventative drug treatments is Botulinum Toxin Type A (Botox®) (see 4.9.3 Drugs used in essential tremor, chorea, tics, and related disorders)
Galcanezumab
  • Solution for injection pre-filled pens 120mg/1ml

Notes

  1. NICE TA659: Galcanezumab (Emgality) is recommended as an option for preventing migraine in adults (November 2020), only if:
    1. they have 4 or more migraine days a month
    2. at least 3 preventive drug treatments have failed and
    3. the company provides it according to the commercial arrangement
  2. Stop galcanezumab after 12 weeks of treatment if:
    1. in episodic migraine (less than 15 headache days a month) the frequency does not reduce by at least 50%
    2. in chronic migraine (15 headache days a month or more with at least 8 of those having features of migraine) the frequency does not reduce by at least 30%
  3. The preferred option in Devon for the treatment of patients with chronic migraine who have failed on at least 3 preventative drug treatments is Botulinum Toxin Type A (Botox®) (see 4.9.3 Drugs used in essential tremor, chorea, tics, and related disorders)

 

Home > Formulary > Chapters > 4. Central Nervous System > 4.7 Analgesics > 4.7.4 Antimigraine drugs

 

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