More than 6 million Brits suffer excruciating migraines to get first targeted drug

Millions of people with regular migraines could be offered the first ever dedicated oral treatment on the NHS.

More than six million Britons suffer from \’episodic migraines\’ with at least four severe headaches a month.

Until now, they were offered medications for other related conditions — such as beta blockers, antidepressants and epilepsy drugs — or injections.

Now the National Institute for Health and Care Excellence (NICE) has approved in England a drug called Rimegepant that is taken as a wafer that dissolves under the tongue.

It works by blocking the release of a protein around the brain called calcitonin gene-related peptide (CGRP) that causes intense inflammation in the coverings of the brain.

About 150,000 patients with episodic migraine, in whom at least three previous treatments have failed, will be offered the drug.

Helen Knight, Director of Medicines Evaluation at NICE, said: “Every year the lives of millions of people in England are ruined by migraine attacks.

“They can be extremely debilitating and can significantly affect a person\’s quality of life. In the comments received during the consultation on the previous draft guidance, patients and carers described migraine as an invisible disability that affects all aspects of life, including family, social activities, mental health, finances and instruction.

Around 10 million people in the UK suffer from some form of migraine.

They affect three times as many women as men, possibly due to differences in sex hormones. Migraine affects one in 10 children.

NICE\’s draft guidance recommends rimegepant – also called Vydura and developed by drugmaker Pfizer – as a preventative treatment for adults who have at least four migraine attacks a month but fewer than 15.

Evidence from clinical trials showed that it worked better than a dummy treatment at reducing headache attacks.

Current treatment options such as beta blockers, antidepressants, and epilepsy medications can have significant side effects and may be ineffective for some people.

The Emicraine Trust welcomed NICE\’s announcement but called for Rimegepant to be offered more widely.

Chief Executive Officer Rob Music said: “Too many people with migraine end up with medication overuse headaches as a result of their migraine treatment, which severely impacts their lives.

“This is a preventable impact if migraine is treated effectively.

“Gepants, the new class of migraine drugs that Rimegepant is a part of, can help prevent this from happening.

\”While we welcome the fact that it 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.\”

There are around 190,000 migraine attacks every day in the UK and until recent years there was very little understanding of what causes them.

Coverings of the brain called the meninges are thought to be responsible for some forms of severe pain associated with migraines.

The CGRP protein transmits pain signals along the trigeminal nerve in the brain and can cause severe inflammation of the meninges.

Previously the only specific treatment for migraines was injections of monoclonal antibodies, the same technique used to boost the body\’s immune system in Covid-19 patients.

NICE recommended erenumab, fremanezumab or galcanezumab are antibody proteins designed to target and neutralize other proteins or their receptors.

So these injections target the CGRP protein or its receptor.

Helen Knight added: “Rimegepant is the first oral migraine treatment recommended by NICE and for many thousands of people it is likely to be a welcome and more convenient addition to existing options for an often overlooked and undertreated condition.

\”Today\’s draft guidance demonstrates our commitment to focus on what matters most and deliver the best care to people while delivering value for the taxpayer.\”

Patient and professional groups now have the opportunity to appeal the draft guidance. If no appeals are received, the final guidance is expected to be published next month.