50% frequency reduction of crippling migraine headaches by proposing a daily pill to NHS patients


It is thought that over 5.6 million people in England have episodic migraines, meaning they experience between four and 14 attacks per month

Migraine sufferers could be given a daily pill from the NHS that could halve the frequency of their crippling headaches.

NHS spending watchdog, the National Institute for Health and Care Excellence (NICE), will decide later this month whether to offer the drug, called atogepant, to patients who have failed to respond to other treatments.

Experts expect the pill, which costs around £8,000 a year per patient, to be approved after research shows it to be significantly more effective than another migraine drug rolled out on the NHS earlier this year.

The new treatment is a type of medication called a CGRP inhibitor that blocks the effect of calcitonin gene-related peptide — a protein known to cause the debilitating headache and nausea of ??migraines.

In recent years, numerous CGRP injections have been approved for use on the NHS. However, a shortage of migraine specialists, who need to be consulted before the injections are prescribed, has led to long waiting lists. Many patients have paid for the injections privately instead, but experts believe that if approved, atogepant could be prescribed by GPs, greatly improving access to it.

It is thought that over 5.6 million people in England have episodic migraines, meaning they experience between four and 14 attacks per month

‘CGRP medicines have been revolutionary, but demand is so high that there is a huge backlog to get a prescription,’ says Ria Bhola, a specialist migraine nurse who works with the charity The Migraine Trust. “Having a pill that you can get from your GP would make a huge difference.”

It is thought that more than 5.6 million people in England have episodic migraines, meaning they experience between four and 14 attacks per month. Most rely on pain relievers to ease the pain, or prescription drugs called triptans, which can shorten the duration of attacks.

In March 2020, the NHS gave the green light to CGRP inhibitors – the first new migraine treatment in over 20 years. There are now three CGRP injections available on the NHS, which can be self-administered once a month.

These were approved for patients who had not responded to other migraine treatments. However, in 2021, The Mail on Sunday revealed that hundreds of patients eligible for CGRP jabs were paying privately up to £350 a month for the drugs, as they could not access them through the NHS.

Experts say this problem, which is still ongoing, is due to a lack of NHS resources.

In May, NICE approved the first CGRP pill, called rimegepant, to prevent migraines in patients who had failed to respond to existing treatments. Studies showed that regular use led to two fewer headache days per month.

However, the pill, taken every other day, was not approved for this use by NHS Scotland regulators, as they believed it was not providing enough benefits.

Most migraine sufferers rely on pain relievers to ease the pain, or prescription drugs called triptans that can shorten the duration of attacks

Most migraine sufferers rely on pain relievers to ease the pain, or prescription drugs called triptans that can shorten the duration of attacks

However, studies show that episodic migraine sufferers who used atogepant experienced fewer headaches on average four days per month – practically twice as effective as rimegepant.

Trial participants had an average of about eight migraine attacks per month prior to the start of treatment, which means that atogepant reduced the risk of the agonizing headache by half.

prof. Peter Goadsby, director of the NIHR King’s College research facility and the scientist who led the discovery of CGRP in 1984, says atogepant can “change the lives” of migraine sufferers.

“The typical patient in the trial was a 40-year-old woman who had struggled with migraines for more than 15 years,” he adds.

While the migraine itself is incredibly painful, the worst thing about the condition is its unpredictability. Something as simple as going out for coffee with friends becomes difficult.

“She tried a number of other medications and none worked particularly well. Some made her sleepy and she even gained weight.

‘But with atogepant it is different. After taking the pill for a few months, she noticed that she had fewer migraines and that the migraine attacks were less severe.

“There are very few side effects – the main one being mild constipation – but it’s nothing a few prunes can’t fix.

“It’s possible that a year of treatment could help reduce the migraines.” But if they come back, there’s no reason patients couldn’t go back to atogepant and keep taking it.”