The Medicines and Healthcare products Regulatory Agency (MHRA) is an executive agency of the Department with responsibility for ensuring medicines meet appropriate standards of quality, efficacy, and safety.

The MHRA has plans to gather the currently available evidence on mental health and other related risks for licensed migraine prophylaxis medications, as referenced in the separate responses to questions HL1488 and HL1543. A formal timeline for this review has not yet been agreed, and consequently we are unable to provide an expected completion date at this stage.

The MHRA is committed to communicating any findings that may have implications for patient safety or the safe use of medicines. The MHRA will sometimes issue communications, such as drug safety updates, after the conclusion of a review. However, the review is at an early stage, and it would be premature to comment on any potential communication plans. In addition, any product information changes that may arise as a result of this review would be reflected in the published product information available at locations such as the MHRA website or the Electronic Medicines Compendium website.

The Medicines and Healthcare products Regulatory Agency (MHRA) is an executive agency of the Department with responsibility for ensuring medicines meet appropriate standards of quality, efficacy, and safety.

The MHRA has plans to gather the currently available evidence on mental health and other related risks for licensed migraine prophylaxis medications, as referenced in the separate responses to questions HL1488 and HL1543. A formal timeline for this review has not yet been agreed, and consequently we are unable to provide an expected completion date at this stage.

The MHRA is committed to communicating any findings that may have implications for patient safety or the safe use of medicines. The MHRA will sometimes issue communications, such as drug safety updates, after the conclusion of a review. However, the review is at an early stage, and it would be premature to comment on any potential communication plans. In addition, any product information changes that may arise as a result of this review would be reflected in the published product information available at locations such as the MHRA website or the Electronic Medicines Compendium website.

The Government is committed to shifting more care from hospitals into community settings, ensuring that patients with chronic conditions such as migraine can access care closer to home. We support integrated, multidisciplinary models of care that bring together primary, community, and specialist services to better meet the needs of people living with long-term conditions, including migraine.

Integrated care boards are responsible for assessing local health needs and commissioning services for their populations, including community services for people with chronic conditions. NHS England's programmes, including Getting It Right First Time, NHS RightCare, and the development of integrated neighbourhood health services, support systems to improve care pathways, reduce unwarranted variation, and strengthen community-based care.

For people with neurological and other long-term neurological conditions like migraine, NHS England's Adult Neurology Service Specification supports the development of high-quality community-based migraine care by promoting integrated neurological pathways that enable patients to receive appropriate assessment, treatment, and ongoing management closer to home wherever possible. The specification encourages collaboration between primary care, community services, and specialist neurology teams, helping to ensure timely access to expert advice, clear referral pathways, and coordinated care for people with migraine. By supporting a multidisciplinary approach and ensuring that specialist services are focused on patients with the most complex needs, the specification aims to improve patient experience, reduce unwarranted variation in care, and make better use of National Health Service resources.

There is no nationally published waiting-time data specifically for headache and migraine services. Patients referred for specialist migraine care are captured within broader neurology statistics. As of the end of May 2026, there are nearly 214,700 pathways on the waiting list for neurology services. 61.4% of neurology pathways are waiting within 18 weeks for first treatment.

Reducing waiting lists, including for neurology services, is a key part of the Government’s Health Mission. We are committed to returning to the National Health Service constitutional standard that 92% of patients wait no longer than 18 weeks from referral to consultant-led treatment by March 2029.

The NHS RightCare Headache and Migraine Toolkit is supporting local NHS systems to improve headache and migraine services, including by providing practical guidance to improve pathways between primary and specialist care, and ensure patients receive the right intervention at the earliest opportunity.

Our 10-Year Health Plan sets a sustainable vision for elective care where by 2035, most outpatient care will happen outside of hospitals. Patients' access to specialists, including neurologists, will be improved by providing this specialist care in the community where possible and increasing digital access to specialists through the NHS App where it’s more convenient for patients.

Individuals or organisations receiving a coroner’s Prevention of Future Deaths (PFD) report have a statutory obligation to respond to the report and a deadline of 56 days to do so.

NHS England has processes in place to review and consider learning from PFD reports relevant to National Health Services. PFD reports may be considered alongside information from a range of sources, including patient safety incident data, clinical evidence, coroner recommendations, and medicines safety information from the Medicines and Healthcare products Regulatory Agency (MHRA).

Where PFD reports identify concerns relating to medicines, including potential toxicity or psychiatric adverse effects associated with preventive migraine treatments, these issues can inform patient safety activity and service improvement work as appropriate. The MHRA is responsible for monitoring the safety of medicines in the United Kingdom through the Yellow Card scheme and other pharmacovigilance processes, and works with partners across the health system to identify and assess emerging safety signals. NHS England and healthcare providers are expected to have regard to relevant safety advice issued by the MHRA.

No assessment has been made of the potential impact of migraine on employment and economic inactivity. This information isn’t available as the Labour Force Survey (LFS), the primary source for data on labour market participation and economic inactivity, only reports figures by long‑term health condition and does not include a category for migraines.

However, LFS data shows that working-age people with a long-term health condition are less likely to be in employment than those without a long-term health condition, at 64.1% compared with 81.6%, and are around twice as likely to be economically inactive, at 31.5% compared with 14.6%. The data is available at the following link:

https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/employmentandemployeetypes/datasets/labourmarketstatusofdisabledpeoplea08

The Office for National Statistics collects information on health conditions through the Labour Force Survey (LFS), which is based on interviews with people resident in households in the United Kingdom. The LFS covers this in two relevant ways. It asks respondents about their general health, including any specific conditions and whether these are long-term conditions that limit their ability to work. It also asks about periods of absence from work on health grounds, including which health condition caused that absence.

The general health section of the survey contains a range of impairment categories, informed by the Government Statistical Service (GSS) Impairment harmonised standard. However, this list does not currently identify headache or migraine-related disorders as a separate category. Such conditions would most likely be categorised as “other health problems or disabilities”. Under the current survey design, it is therefore not possible to identify people whose long-term work-limiting illness is specifically related to headaches or migraines. The GSS Harmonisation team is currently reviewing the disability and impairment standards, including the review of disability data harmonised standards, which is available at the following link:

https://analysisfunction.civilservice.gov.uk/policy-store/review-of-disability-data-harmonised-standards-findings-from-phase-2-of-our-research/

Any recommendations from that review would be considered when assessing future updates to the impairment categories collected through the LFS.

Meanwhile, the section about periods of absence from work on health grounds includes an option for headaches and migraines. Analysis using this classification is published regularly as part of an article on Sickness absence in the UK labour market, which is available at the following link:

https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/employmentandemployeetypes/datasets/sicknessabsenceinthelabourmarket

As the question is linked to specific periods of absence, it cannot be used to estimate the number of people who may be affected by migraine or headache related disorders. Instead, it looks at the number of days lost from work through different reasons for sickness absence, including headaches and migraines, along with the number of occurrences of sickness absence.

The Medicines and Healthcare products Regulatory Agency (MHRA) is an executive agency of the Department with responsibility for ensuring medicines meet appropriate standards of quality, efficacy, and safety.

The MHRA has plans to gather the currently available evidence on mental health and related risks for licensed migraine prophylaxis medications, as referenced in a response to HL1488. Prescribing safety will be considered as part of this review within the scope of the MHRA’s remit. This will include, for example, assessing how prescribing conditions are described in the product information of relevant migraine medicines. However, clinical practice, national or regional clinical guidelines, and a healthcare professional’s decision to prescribe a particular medicine are outside the MHRA’s direct scope of work.

The Government is committed to working collaboratively to support disabled people and people with health conditions, including people affected by migraine. The Department of Health and Social Care and the Department for Work and Pensions’ Joint Work and Health Directorate was established to co-ordinate Government activity to help disabled people and people with health conditions get good work, get on in that work, and to return to work as quickly as possible if they leave it.

The Department of Health and Social Care and the Department for Work and Pensions have a range of specialist initiatives, including those joining up health and employment support around the individual through programmes such as Employment Advisors in NHS Talking Therapies and WorkWell, as well as support from Work Coaches and Disability Employment Advisers in Jobcentres and Access to Work grants. Ministers and officials have regular conversations with regard to employment support for people whose ability to work is affected by a health condition.

The Government’s 10-Year Health Plan, published in July 2025, builds on existing work to better integrate health with employment support and incentivise greater cross-system collaboration. The plan outlines how the neighbourhood health service will join up support from across the work, health, and skills systems to help address the multiple complex challenges that often stop people finding and staying in work and deliver holistic care that leads to better employment outcomes for all.

Employers are also crucial in enhancing employment opportunities and supporting disabled people and people with health conditions, such as migraines, to thrive in the workforce. To encourage employers to create disability inclusive workplaces, the Government continues to oversee the Disability Confident Scheme. This provides resources such as the Disability Confident Manager’s Guide, which includes guidance on flexible working and workplace adjustments, and which is available at the following link:

https://www.gov.uk/government/publications/disability-confident-and-cipd-guide-for-line-managers-on-employing-people-with-a-disability-or-health-condition

The Government’s offer to employers also comprises tailored guidance on supporting disabled people and people with health conditions in the workplace through its Support with Employee Health and Disability service. This includes guidance on disclosures and having conversations about health and disabilities, plus guidance on legal obligations and making reasonable adjustments. Further information on the Support with Employee Health and Disability service is available at the following link:

https://www.support-with-employee-health-and-disability.dwp.gov.uk/support-with-employee-health-and-disability

Additionally, in November 2025, Sir Charlie Mayfield published the Keep Britain Working Review, setting out recommendations to reshape how the Government works with employers to improve work and health outcomes through creating healthier, more inclusive workplaces. The Government is now working with volunteer employers, providers, and regions through a Vanguard Phase to test and refine approaches to help disabled workers and workers with long-term health conditions, including people affected by migraine, receive the support they need to remain and thrive in employment. Alongside the Department of Health and Social Care, the Department for Work and Pensions, and the Department for Business and Trade, National Health Service organisations are already participating in the Keep Britain Working Vanguard Phase to design a healthy working lifecycle standard and the accompanying Workplace Health Provision.

The Government is committed to working collaboratively to support disabled people and people with health conditions, including people affected by migraine. The Department of Health and Social Care and the Department for Work and Pensions’ Joint Work and Health Directorate was established to co-ordinate Government activity to help disabled people and people with health conditions get good work, get on in that work, and to return to work as quickly as possible if they leave it.

The Department of Health and Social Care and the Department for Work and Pensions have a range of specialist initiatives, including those joining up health and employment support around the individual through programmes such as Employment Advisors in NHS Talking Therapies and WorkWell, as well as support from Work Coaches and Disability Employment Advisers in Jobcentres and Access to Work grants. Ministers and officials have regular conversations with regard to employment support for people whose ability to work is affected by a health condition.

The Government’s 10-Year Health Plan, published in July 2025, builds on existing work to better integrate health with employment support and incentivise greater cross-system collaboration. The plan outlines how the neighbourhood health service will join up support from across the work, health, and skills systems to help address the multiple complex challenges that often stop people finding and staying in work and deliver holistic care that leads to better employment outcomes for all.

Employers are also crucial in enhancing employment opportunities and supporting disabled people and people with health conditions, such as migraines, to thrive in the workforce. To encourage employers to create disability inclusive workplaces, the Government continues to oversee the Disability Confident Scheme. This provides resources such as the Disability Confident Manager’s Guide, which includes guidance on flexible working and workplace adjustments, and which is available at the following link:

https://www.gov.uk/government/publications/disability-confident-and-cipd-guide-for-line-managers-on-employing-people-with-a-disability-or-health-condition

The Government’s offer to employers also comprises tailored guidance on supporting disabled people and people with health conditions in the workplace through its Support with Employee Health and Disability service. This includes guidance on disclosures and having conversations about health and disabilities, plus guidance on legal obligations and making reasonable adjustments. Further information on the Support with Employee Health and Disability service is available at the following link:

https://www.support-with-employee-health-and-disability.dwp.gov.uk/support-with-employee-health-and-disability

Additionally, in November 2025, Sir Charlie Mayfield published the Keep Britain Working Review, setting out recommendations to reshape how the Government works with employers to improve work and health outcomes through creating healthier, more inclusive workplaces. The Government is now working with volunteer employers, providers, and regions through a Vanguard Phase to test and refine approaches to help disabled workers and workers with long-term health conditions, including people affected by migraine, receive the support they need to remain and thrive in employment. Alongside the Department of Health and Social Care, the Department for Work and Pensions, and the Department for Business and Trade, National Health Service organisations are already participating in the Keep Britain Working Vanguard Phase to design a healthy working lifecycle standard and the accompanying Workplace Health Provision.

The Government recognises the significant impact that migraine can have on individuals’ quality of life and is committed to improving care and outcomes for people living with this condition.

NHS England is supporting improvements in migraine care through national programmes such as the RightCare headache and migraine toolkit and the Getting It Right First Time neurology programme. These initiatives support earlier diagnosis, more effective management in primary care, and better access to specialist services where needed, helping to reduce unwarranted variation in care and improve patient outcomes.

To support consistent, high-quality care, the National Institute for Health and Care Excellence (NICE) has published clear, evidence-based guidance on the diagnosis and management of headaches, including migraine. This guidance helps clinicians to diagnose migraine more promptly and provide appropriate acute and preventive treatments based on individual clinical need.

In August 2025, NHS England updated its service specification for specialised adult neurology services. It outlines a number of minimum service requirements for key specialties, including complex headache services.

Over the last five years, a new class of drugs, calcitonin gene-related peptide (CGRP) inhibitors, has been made available on the National Health Service for the prevention and treatment of episodic and chronic migraines. Atogepant is the latest CGRP inhibitor to be recommended by NICE for use as a prevention and acute treatment of migraine.

The National Institute for Health and Care Excellence (NICE) has recommended several new medicines as options for the treatment of migraine. The National Health Service in England is legally required to fund medicines recommended in a NICE appraisal, usually within three months of final guidance.

The NHS England Neurology Transformation Programme has developed a neurology toolkit for integrated care boards (ICBs) which includes guidance on optimising system-wide headache pathways, including for migraine. This guidance will provide support to ICBs in reducing regional variation in access to NICE-recommended Calcitonin Gene-Related Peptide and gepant migraine treatments for patients, including options for improving community-based services that reduce outpatient waiting lists and improve timely access to diagnosis and treatment.

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.

The safety of medicines is closely monitored through the Medicines and Healthcare products Regulatory Agency’s (MHRA) pharmacovigilance system. Reports submitted through the Yellow Card Scheme are used by the MHRA to identify and investigate potential adverse drug reaction signals, including psychiatric adverse effects. Where a safety concern is identified, the MHRA can take regulatory action and communicate new safety information to healthcare professionals and patients.

National clinical guidance and care pathways are informed by the best available evidence, including emerging medicines safety information. The National Institute for Health and Care Excellence keeps its guidance under review and considers new evidence and safety information when determining whether recommendations should be updated. Medicines safety concerns may also be considered through National Health Service medicines governance and patient safety processes.

Coroners’ Prevention of Future Deaths (PFD) reports provide an important source of patient safety learning. NHS England has established processes to review, analyse, and identify themes arising from PFD reports and to escalate issues where further action is required. Learning from PFD reports can, therefore, inform wider patient safety improvement work, including service design and clinical practice where relevant.

The Medicines and Healthcare products Regulatory Agency (MHRA) is an executive agency of the Department with responsibility for ensuring medicines meet appropriate standards of quality, efficacy, and safety.

The MHRA has recently received a report relating to the use of migraine medicines and the effect on mental health from a patient. As a result, the MHRA plans to gather the currently available evidence on mental health and related risks for licensed migraine prophylaxis medications and consider whether this suggests a need to update or change existing warnings in the relevant product information. The review would include an assessment of suspected adverse drug reactions recorded within the Psychiatric Disorders System Organ Class in relation to licensed migraine prophylaxis medication use as well as other data sources such as scientific literature.

The MHRA encourages anyone to report if they suspect an adverse reaction to a medical product or products. Further information on Yellow Card reporting is available at the Yellow Card website.

The economic impact of migraines is recognised to arise from a range of factors, including working days lost and labour market participation. The latest data from the Office for National Statistics (ONS) shows that 3.1 million days were lost due to headaches and migraines in 2024. No information is available on the potential impact of migraine on labour market participation as no data is available from the Labour Force Survey - the primary source for such data.

We have a range of specialist initiatives to support individuals to stay in work and get back into work, including those that join up employment and health systems.

Existing measures include support from Work Coaches and Disability Employment Advisers (DEAs) in Jobcentres and Access to Work grants. Our Pathways to Work support offer will ensure a coherent and navigable offer of support, building on and bringing together initiatives such as Connect to Work, WorkWell and local Trailblazers. Already, our Supported Employment programme, Connect to Work, is supporting disabled people, people with health conditions and people with complex barriers to employment across England and Wales.

The Get It Right First Time (GIRFT) programme is a clinically led improvement programme which aims to reduce unwarranted variation in care by using data, peer review, and best practice guidance across a range of specialties, including neurology. While GIRFT supports improvements in prescribing practice and clinical decision-making, it does not set formal governance requirements or mandate for the assessment of specific clinical factors, such as a patient’s psychiatric history, use of psychotropic medicines, or previous adverse drug reactions. Instead, the GIRFT Neurology workstream focuses on improving the care pathway for migraine patients by reducing variation in National Health Service care, improving outpatient waiting times, and building better pathways between general practitioners and hospital specialists.

Clinical responsibility for considering these factors rests with individual healthcare professionals, who are expected to assess the full clinical picture when initiating or reviewing treatment, including at the migraine prescribing interface. National Institute for Health and Care Excellence guidance, including that on headache and migraine, supports safe prescribing by emphasising the importance of taking into account co-morbidities, potential drug interactions, and patient history when selecting treatments.

NHS England also promotes a multidisciplinary, patient-centred approach to care, particularly where there is clinical complexity, including mental health comorbidity. GIRFT complements this by identifying opportunities to improve pathways and consistency of care, but governance arrangements for clinical assessment and prescribing decisions are determined locally by providers and commissioners, in line with national guidance and professional standards.

The Department has no plans to make a further assessment beyond the position set out in the Answer of 15 June 2026 to Question 7593.

The impact of fluctuating conditions are already considered within Work Capability Assessments in Universal Credit (UC) and New Style Employment and Support Allowance, and within Personal Independence Payment assessments and in applications to Access to Work. Changes introduced through the UC Act 2025 do not affect how fluctuating conditions are considered.

At the heart of reforms such as this year’s Universal Credit Act and the Right to Try Guarantee is the principle that those who can work should work, but if you need help into work the government should support you, and those who can’t work should be supported to live with dignity.

Through the upcoming reviews of the welfare system led by Alan Milburn and Stephen Timms, we will ensure that our approach to support is fit and fair for the future, promotes independence, and enables full participation in society as possible.

Employers are crucial in enhancing employment opportunities and supporting disabled people and those with health conditions, such as migraines, to thrive in the workforce.

This Government is committed to working collaboratively to support people who are managing health conditions. DWP and DHSC’s Joint Work and Health Directorate was set up to co-ordinate Government activity which helps those managing health conditions and disabled people to get into and thrive in work.

There are a range of initiatives that provide support. The Disability Confident Scheme encourages employers to create disability inclusive workplaces and to support disabled people to get work and get on in work. The scheme provides resources such as the Disability Confident Manager’s Guide, which includes guidance on flexible working and workplace adjustments.

WorkWell offers integrated work and health support for people with health-related barriers to work and is being expanded across England, backed by up to £259m, over the next three years. Participants receive person-centred, early support based on their health-related barriers to employment, and a tailored support plan that can include employer liaison and advice on workplace adjustments.

In November 2025, Sir Charlie Mayfield published the Keep Britain Working Review, setting out recommendations to reshape how Government works with employers to improve work and health outcomes through creating healthier, more inclusive workplaces. We are now working with volunteer employers, providers and regions through a Vanguard Phase to test and refine approaches to help disabled workers and workers with long-term health conditions, including those affected by migraine, receive the support they need to remain and thrive in employment. These include developing effective stay in work and return to work practices, strengthening prevention, and building the evidence needed to spread good practice.

The 10 Year Health Plan, published in July 2025, builds on existing work to better integrate health with employment support and incentivise greater cross-system collaboration, recognising good work is good for health. The Plan outlines how the neighbourhood health service will join up support from across the work, health and skills systems to help address the multiple complex challenges that often stop people finding and staying in work and deliver holistic care that leads to better employment outcomes for all.

We are fully committed to ensuring adequate support in the social security system for those who – through ill health or disability – are unable to work.