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 Formulary Chapter 4: Central nervous system - Full Chapter
04.07.04.01  Expand sub section  Treatment of the acute migraine attack
04.07.04.01  Expand sub section  Analgesics
04.07.04.01  Expand sub section  5HT1 agonists
Sumatriptan 
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First Choice
Green

Sumatriptan (as Sumatriptan succinate) Tablet 100mg 
Sumatriptan (as Sumatriptan succinate)  Tablet 50mg 

1st line triptan.
(As per Anti-Migraine Prescribing Guide)

 
Sumatriptan nasal spray

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First Choice
Green

Sumatriptan Aq Nasal Spray 10mg/0.1ml Unit dose
Sumatriptan Aq Nasal Spray 20mg/0.1ml Unit dose

1st line triptan for young people 12-17 years 
(As per Anti-Migraine Prescribing Guide)

 
Zolmitriptan 
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Second Choice
Green

Zolmitriptan Orodispersible Tablets 2.5mg
Zolmitriptan Orodispersible Tablets 5mg
Zolmitriptan Tablets 2.5mg
Zolmitriptan Tablets 5mg

2nd line triptan. 
(As per Anti-Migraine Prescribing Guide)

NICE (CG150) recommends this for Menstrual-related Migraine. If this is not tolerated then consider Frovatriptan 2.5mg tablets instead (Unlicensed indication).

 
Link  NICE CG150: Headaches in over 12s: diagnosis and management
   
Almotriptan (Almogran)
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Third Choice
Green

Almotriptan (as Almotriptan hydrogen malate) Tablets 12.5mg

3rd line triptan
(As per Anti-Migraine Prescribing Guide)

 
   
Rizatriptan (Maxalt)
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Fourth Choice
Green

Rizatriptan (as Rizatriptan benzoate) Orodispersible Tablets 10mg
Rizatriptan (as Rizatriptan benzoate) Tablets 5mg
Rizatriptan (as Rizatriptan benzoate) Tablets 10mg
Rizatriptan (as Rizatriptan benzoate) Oral Lyophilisates 10mg

4th line triptan
(As per Anti-Migraine Prescribing Guide)

 
   
Frovatriptan 
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Formulary
Green

Frovatriptan (as Frovatriptan succinate monohydrate) Tablets 2.5mg

Restriction: For menstrual-related migraine not responding to standard treatment. (As per Anti-Migraine Prescribing Guide)

NICE (CG150) Recommend this for Menstrual-related Migraine. If this is not tolerated then consider Zolmitriptan 2.5mg tablets instead (Unlicensed indication).

 
Link  NICE CG150: Headaches in over 12s: diagnosis and management
   
Zolmitriptan nasal spray
(Zomig)
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Formulary
Green

Zolmitriptan 5mg/0.1ml Nasal Spray 0.1mg unit dose

Not for children under 18 years
(As per Anti-Migraine Prescribing Guide)

1 spray of Zomig® nasal spray = 5 mg zolmitriptan.

 
   
04.07.04.01  Expand sub section  Other drugs for migrane
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Red

Medicines that can only be prescribed within Secondary Care. Examples of medicines which fall into this category are: Certain new medicines and new indications for older medicines where there is at present no experience of use in Primary Care. Medicines or dressings not available or prescribable in Primary Care. Where a medicine has been classified as Amber E, but an approved shared-care guideline is not yet available   

Amber

Medicines which can be prescribed within Secondary Care, but are only suitable for prescribing in Primary Care after specialist referral. There is no need for approved shared care guidelines for medicines in this category. This replaces Amber 2 on the North Staffs Formulary.   

Amber E

Medicines which can be prescribed within Secondary Care, but are only considered suitable for prescribing in Primary Care under an approved shared-care agreement (ESCA) or Rationale for Initiation, Continuation and Discontinuation (RICaD). This replaces Amber 1 on the North Staffs Formulary  

Green

Medicines which can be prescribed in either Primary or Secondary Care.  

Grey

These medicines have been reviewed by the New Medicines Committee and the Area Prescribing Committee and found not to be suitable for inclusion in the Joint Formulary. Inadequate or weak evidence for efficacy No clearly defined local need Lack of long term safety data No perceived benefit over established formulary alternatives Prescribers can consider these medicines where formulary alternatives are unsuitable, ineffective or not tolerated.  

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