The Scottish Intercollegiate Guidelines Network has published SIGN 155 on Pharmacological management of migraine, including a treatment pathway algorithm.

Migraines are the most common severe form of primary headache in the world. It is estimated that the healthcare costs, lost productivity, and disability associated with migraines lead to direct and indirect costs of around £3 billion to the UK. Causes can vary, but twice as many women as men are affected by migraines, which is thought to be a result of hormone changes during the menstrual cycle.

In primary and secondary care, migraine is often underdiagnosed or misdiagnosed, and can be undertreated even when correctly diagnosed.

In recent years there have been significant advances in diagnosis and treatment of migraine with new acute and preventative treatments still in development, with some (such as botulinum toxin A) already in use.

The guidance covers a number of aspects of migraine management, including:

  • treatment for patients with acute migraine
  • pharmacological prevention of migraine
  • medication-overuse headache
  • devices for migraine therapy
  • provision of information.

The guideline also updates and replaces section 6 of SIGN 107 on Diagnosis and management of headache in adults.