Following review and Greater Manchester-wide consultation, the GMMMG headache pathway has been updated and is now available on the Clinical Guidance and Pathways page. The formulary and RAG list have also been updated to reflect the guidance, including:

  • Additional options for simple analgesia and antiemetics
  • Clearer guidance on choice of triptan
  • Additional options for migraine prophylaxis in primary care, including metoprolol, amitriptyline, nortytipyline, candesartan. Zonisamide has also been added, for use following specialist advice
  • Flunarazine added as a RED drug
  • Additional options for acute treatment of cluster headache: zolmitriptan nasal spray, and oxygen.
  • Additional option for cluster headache prophylaxis: verapamil (following specialist advice)