Many people with migraine could benefit from preventive treatment, if they’re experiencing frequent or severe migraine attacks. However, commonly used oral preventive medications often have side effects and finding a medication that works for you can be a matter of trial and error.
We’ve developed a summary of information about migraine preventive medications for GPs that has been reviewed and checked by several members of our Clinical Advisory Group. This includes when and how to start preventive medication, what the expected goals of prevention are and how to monitor whether medications are effective. It also includes a list of preventive medications used in New Zealand and when review by a specialist is advisable.
We developed this based on international guidelines and consensus statements and what we know is common practice in New Zealand. Although New Zealand doesn’t currently have a national guideline on migraine and headache management, we can adapt best practice from evidence-based recommendations from other countries, matched to what medications are available here.
GPs can also use Health Pathways to find guidance on migraine treatments. Health Pathways are online resources designed to help primary health practitioners to diagnose, manage and refer patients appropriately. However, there are 11 different pathways and the information can vary depending on where you live. These pathways are not open to the public to view.
We’ve been in contact with people at Te Whatu Ora who are working on harmonising these pathways across the country and minimising local differences (especially in access to diagnostic tests such as scans and treatment options), and they’re updating the migraine and headache pathways in consultation with one of our Clinical Advisory Group neurologists. We’ve also asked about making the pathways transparent and accessible to consumers – but this is a long term project.
In the meantime, we’ve turned our information into a downloadable document people with migraine can also use and refer to when they want to know more about preventive medication options. It’s also on our website under the ‘Health Professionals’ tab. For more details about specific medications, check out the Healthify website. We also have a similar document on treating migraine attacks.
Further reading
Evidence table of migraine preventive medications (summary of recommendations from six international guidelines/consensus statements)
