Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, with reference to the Answer of 1 July 2026 to Question 10227 on Migraines: Drugs, which specific NICE guidance addresses the prescribing interface between preventive migraine treatment and psychiatric comorbidity, including the identification and recording of psychiatric history, psychotropic medication use and previous psychiatric adverse drug reactions, for patients with both conditions.

The National Institute for Health and Care Excellence (NICE) guideline CG150, Headaches in over 12s: diagnosis and management, provides recommendations on the assessment and treatment of migraine, including preventive treatments, and highlights important safety considerations for certain medicines.

The guideline advises clinicians to take account of relevant safety information, contraindications, and patient-specific risk factors when selecting treatment. Before starting preventive treatments, including propranolol or amitriptyline, healthcare providers must evaluate the patient’s comorbidities, psychiatric history, and risk for adverse drug reactions and discuss the benefits and risks with the patient, specifically taking into account these factors.

When prescribing propranolol, the guideline advises that clinicians use caution in patients with a history of depression to minimise the risk of self-harm, drug toxicity, or rapid deterioration in overdose. Also, when considering amitriptyline as a preventive treatment, clinicians are directed to follow NICE guidance, Medicines Associated with Dependence or Withdrawal Symptoms, reference code NG215, regarding safe prescribing, managing adverse reactions, and safe withdrawal.

Guideline CG150 makes it clear that clinicians should take the guidance fully into account alongside the individual needs, preferences, medical history, and the circumstances of each patient when exercising their clinical judgement.