Thousands could benefit from new migraine drug

In the draft guidance, the National Institute for Health and Care Excellence (NICE) has said it will recommend rimegepant for the prevention of migraines in the 145,000 adults for whom at least three previous preventative treatments have proven unsuccessful.

Rimegepant, a freeze-dried wafer which dissolves under the tongue, works by preventing a protein called calcitonin gene-related peptide (CGRP) from binding to its targets in the brain, thus preventing the inflammation and debilitating pain associated with migraine attacks.

NICE has green-lit the drug for those suffering from episodic migraines – defined as more than four, but fewer than fifteen migraines per month. Final guidance is expected next month if there are no appeals.

The medicine regulator has not previously recommended an oral medicine for migraine prevention, with other recommended treatments – such as erenumab – being administered via injection.

It is hoped that the pill could prove more effective and convenient than traditional migraine treatments, such as beta blockers and antidepressants, which can have significant side effects and yield poor results.

Symptoms of migraines, which can last up to 72 hours, include disturbed vision, sickness, vomiting, and sensitivity to sound and light.

Helen Knight, NICE Director of Medicines Evaluation, hopes the drug could improve the quality of life of the 5.6 million adults in England who live with episodic migraines: “Patients and carers [describe] migraine as an invisible disability that affects all aspects of life, including family, social activities, mental health, finances and education.

“For many thousands of people, [rimegepant] is likely to be a welcome and more convenient addition to existing options for a condition that is often overlooked and undertreated.”

The drug regulator has also published draft guidance for consultation that did not recommend rimegepant for acute migraines – a decision which has been met with disappointment.

Rob Music, Chief Executive of the Migraine Trust, said “While we welcome that [the drug] has been approved for the preventive treatment of migraine, we are very disappointed by the decision not to approve it for the acute treatment of migraine.

“Too many people with migraine end up with medication overuse headache as a result of their migraine treatment, which has a serious impact on their lives. This is an impact which is preventable if migraine is treated effectively.”

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