Guidance

This guideline covers advice on the diagnosis and management of tension-type headache, migraine (including migraine with aura and menstrual-related migraine), cluster headache and medication overuse headache in young people (aged 12 years and older) and adults. It aims to improve the recognition and management of headaches, with more targeted treatment to improve the quality of life for people with headaches, and to reduce unnecessary investigations.

 Topiramate: In June 2024, the Medicines and Healthcare products Regulatory Agency (MHRA) published a Drug Safety Update on topiramate. Topiramate should not be used for migraine prophylaxis in pregnancy. Topiramate should not be used in women of childbearing potential unless the conditions of the Pregnancy Prevention Programme are fulfilled. See the MHRA’s advice for healthcare professionals to provide to patients currently taking topiramate. NICE is assessing the impact of this alert on recommendations in this guideline.

In December 2021, we changed the strength of our recommendation on metoclopramide or prochlorperazine for acute migraine from ‘offer’ to ‘consider’, to better reflect the balance of benefits and risks of these treatments.

Recommendations

This guideline includes recommendations on:

Who is it for?

  • Healthcare professionals who provide care for young people and adults with headaches
  • Young people (12 years and older) and adults with headaches, and their families and carers. Particular consideration is given to the needs of girls and women of reproductive age 

Guideline development process

How we develop NICE guidelines

This guideline was previously called headaches: diagnosis and management of headaches in young people and adults.

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.