NICE Guideline Update: Headaches in Over 12s – Diagnosis and Management

NICE has issued a significant update to Clinical Guideline CG150, focusing on the diagnosis and management of headaches in individuals aged 12 years and older. This comprehensive guideline addresses various headache disorders, including tension-type headaches, migraines (with or without aura), cluster headaches, and medication overuse headaches. The 2025 revision introduces critical changes, particularly in the prophylactic treatment of migraines, reflecting new safety data and regulatory advice.

Key updates include:

• Revised Recommendations for Migraine Prophylaxis: The guideline now advises healthcare professionals to consider propranolol, topiramate, or amitriptyline for migraine prevention, rather than offering propranolol or topiramate as first-line options. This change accounts for updated safety profiles and regulatory guidance.

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• Safety Considerations for Propranolol: Due to the potential risk of self-harm in individuals with depression, caution is advised when prescribing propranolol. Healthcare providers should assess the risk of toxicity and rapid deterioration in overdose situations

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• Topiramate Use Restrictions: Topiramate is contraindicated for migraine prophylaxis during pregnancy and in women of childbearing potential unless the conditions of the Pregnancy Prevention Programme are met.

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• Inclusion of New Therapeutic Options: The guideline incorporates recommendations for newer treatments, such as calcitonin gene-related peptide (CGRP) inhibitors, including rimegepant, atogepant,...