Pharmacological management of migraine (SIGN)
This toolkit summarises the evidence-based recommendations in SIGN 155: Pharmacological management of patients with migraine. For the full guideline see www.sign.ac.uk/our-guidelines/pharmacological-management-of-migraine/ (2023).
IMPORTANT! In June 2024 the MHRA issued new safety measures for the use of topiramate during pregnancy due to risks to the unborn child. Topiramate should not be used in women of childbearing potential unless the conditions of the Pregnancy Prevention Programme are fulfilled. This aims to ensure that all women of childbearing potential: are using highly effective contraception, have a pregnancy test to exclude pregnancy before starting topiramate, and are aware of the risks from use of topiramate. Further information is available: Topiramate (Topamax): introduction of new safety measures, including a Pregnancy Prevention Programme. The guideline is under review to take account of this advice.
Evidence-based recommendations are identified using an 
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Recommended best practice based on the clinical experience of the guideline development group, are denoted by 
