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 7 July 2026 to Question 15439, which national clinical guideline or professional standard sets out the requirement for healthcare providers to evaluate a patient's comorbidities, psychiatric history and risk of adverse drug reactions before initiating preventive migraine treatment; and where in that guideline or standard the requirement is stated.

The National Institute for Health and Care Excellence (NICE) guideline CG150, Headaches in over 12s: diagnosis and management, explicitly directs healthcare professionals to discuss the benefits and risks of prophylactic treatment with the patient, taking into account the patient’s preferences, comorbidities, and the risk of adverse events, as per Recommendation 1.3.17.

While "comorbidities" and "adverse events" serve as the overarching rule for all preventatives, NICE includes explicit instructions to evaluate psychiatric history and self-harm risks when choosing specific first-line medications, specifically Propranolol and Amitriptyline, as per Recommendation 1.3.18. For clinicians considering Amitriptyline as a preventative option, CG150 directs them to align their evaluation with NICE Guideline NG215, Medicines associated with dependence or withdrawal symptoms, requiring a thorough review of the patient's full medical and psychological history before prescribing.