Conditions we write for.
Every condition here is mapped to the NICE guideline your GP is expected to follow. Pick yours to see what they should already be doing — by guideline number, by section.
Long COVID
NICE NG188 sets out how the NHS should assess, refer and manage people with ongoing symptomatic COVID-19 and post-COVID-19 syndrome. It explicitly covers fatigue, breathlessness, brain fog, post-exertional malaise, and autonomic symptoms.
ME/CFS
NICE NG206 (2021) replaced the old CG53 guideline. It explicitly removes graded exercise therapy as a treatment, requires recognition of post-exertional malaise, and sets a clear diagnostic pathway.
Fibromyalgia
NICE NG193 covers the assessment and management of chronic primary pain, including fibromyalgia. It sets out specific recommendations for assessment, shared decision-making, and which pharmacological treatments should and should not be offered.
POTS / dysautonomia
POTS is increasingly recognised, particularly post-COVID. NG188 covers autonomic symptoms in the post-COVID context; broader Royal College of Physicians guidance also exists. The letter cites the relevant authority for your situation.
EDS / HSD
Hypermobile EDS and Hypermobility Spectrum Disorder are recognised in the NICE Clinical Knowledge Summaries. Diagnosis follows the 2017 international classification (Beighton score plus systemic criteria).
MCAS
MCAS is recognised by the British Society for Allergy and Clinical Immunology (BSACI) and is diagnosed against the international consensus criteria (Valent et al., 2012, updated 2019): (1) typical multi-system mast cell mediator symptoms, (2) objective evidence of mast cell mediator release — most commonly a rise in serum tryptase of at least 20% above baseline plus 2 ng/mL, measured within 1–4 hours of a symptomatic episode, and (3) response to mast-cell-directed treatment (H1/H2 antihistamines, mast cell stabilisers).
Endometriosis
NICE NG73 sets out a clear pathway for assessment, investigation and referral of suspected endometriosis. It is explicit that diagnosis should not depend on transvaginal ultrasound being normal.
Perimenopause / HRT
NICE NG23 covers identification and management of perimenopause and menopause, including when HRT should be offered, discussed, and reviewed. It is explicit that diagnosis in women over 45 with typical symptoms should not require blood tests.
Adrenal insufficiency
NICE NG243 (2024) sets out how primary care should suspect, test for, and manage adrenal insufficiency — a condition that can be life-threatening if missed. The guideline is explicit about when a 9am cortisol and short Synacthen test should be requested.
Migraine
NICE CG150 sets the diagnostic pathway for migraine and the order in which preventive treatments should be tried (propranolol, topiramate, amitriptyline, candesartan). Once a patient has failed at least four preventives, separate NICE Technology Appraisals cover CGRP monoclonal antibody injections (TA682 erenumab, TA659 galcanezumab, TA764 fremanezumab, TA871 eptinezumab) and TA260 covers Botox for chronic migraine.
Cluster headache
NICE CG150 explicitly covers cluster headache. Acute attacks should be treated with 100% high-flow oxygen (prescribed via the Home Oxygen Order Form / HOOF) and subcutaneous or nasal sumatriptan. Prevention is usually verapamil with ECG monitoring, with a short corticosteroid course as a bridge. Urgent neurology referral is recommended on first suspicion.
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