Management of Headaches and Migraines in Adults
Kent & Medway CCG Guidance
K&M Botulinum toxin type A and calcitonin gene-related peptide inhibitors for preventing migraine in adults, April 2021 (review due April 2022
K&M Rimegepant Prescribing Guideline for Primary Care, June 2024
K&M Management of Adults with Headaches and Migraines in Primary Care, Aug 2022 (review due Aug 2024)
Please note that this guidance refers to Fremanezumab NICE TA 631, which has since been updated to NICE TA 764. The guidance has not yet been updated following this NICE TA update.
Rimegepant & Atogepant Prescribing Guidance
|
Rimegepant (acute) |
Rimegepant (preventative) |
Atogepant (preventative) |
|
|
STOP if less than 50% reduction in headache days |
STOP if less than 50% reduction in headache days |
12 weeks initial treatment |
|
|
Formulary status
|
Primary care/GP initiation, prescribing and monitoring
|
Secondary care/Community Specialist initiation and continuation |
(pending for atogepant) |
|
Chronic Migraine (Prophylaxis (15 or more headache days a month, 8 with migraine symptoms)) |
No |
No |
Yes |
|
Episodic Migraine - High frequency (Prophylaxis - more than 4 and fewer than 15 headache days a month) |
N/A |
Yes |
Yes |
|
Acute Migraine rescue |
Yes (Triptans contraindicated and NSAIDs and paracetamol tried but ineffective) |
N/A |
No |
|
Secondary care/Community Specialist initiation |
Yes |
Yes |
Yes |
|
GP initiation |
Yes |
No |
Pending |
|
Secondary care/Community Specialist monitoring |
Yes |
Yes |
Pending |
|
GP monitoring |
Yes |
No |
Pending |
|
Blueteq availability* (GP surgery/Primary care) |
No |
No |
No |
|
Blueteq availability* (Secondary care/Community Specialist providers) |
No |
Yes |
Yes |
|
ICB approved to use |
Yes |
Yes |
Pending (approved use currently in Secondary care only) |
|
Homecare availability in GP surgery/Primary care |
No |
No |
No |
|
Homecare availability (Secondary care/Community Specialist providers) |
No |
Yes |
Yes |