Good news for migraine sufferers but access to treatment could still cause a headache

12-Apr-2024 - Last updated on 12-Apr-2024 at 14:01 GMT

Yesterday's migraine treatment breakthrough, though amidst a complex journey to find a cure, still promises a dramatic impact despite the absence of a 'magic bullet.'

The National Institute for Health and Care Excellence (NICE) has endorsed atogepant, a novel oral medication, as a preventive treatment for both chronic and episodic migraines. This recommendation is poised to change migraine management for up to 170,000 individuals across England.

Atogepant, also known as Aquipta and produced by AbbVie, represents a major shift in migraine therapeutics. It has been recommended by NICE for adults who experience at least four migraine days per month and have unsuccessfully tried at least three previous preventive treatments.

The impact of migraines is profound, affecting approximately 4.5 million people in England alone. Chronic migraine, characterized by at least 15 headache days per month, poses a particularly daunting challenge, often significantly disrupting daily life and exacting a heavy toll on both patients and the healthcare system.

Atogepant operates by blocking the calcitonin gene-related peptide (CGRP) receptor, a pivotal player in migraine pathophysiology. Administered orally as a tablet, it offers a convenient and effective means of migraine prevention.

Dan Tickle (pictured), chief executive of The National Migraine Centre was asked by Outsourcing Pharma, why treatment for migraines is taking so long to develop.

He explained that a breakthrough in 1984 was the beginning of a long process that is bringing many of the benefits we are seeing today.

He said: “It was discovered that Calcitonin Gene-Related Peptide (CGRP), a type of protein, can build up in the nervous system and trigger migraine attacks. It took more than 30 years before that discovery really changed the way we treatment migraine. Today, we have access to a range of anti-CGRP medications, from injectables and infusions to the new oral medications, such as atogepant.

Dramatic impact on migraine

“While there’s no magic bullet, for many people these medications can have a really dramatic impact on migraine, careers, mental health and relationships.”

Tickle said the Centre does remain concerned about access to the treatment.

He said: “We remain concerned that many patients are reporting to us that, in reality, anti-CGRPs remain extremely difficult to access through the NHS. Not all those with migraine will be considered, waiting times are long, and patients will usually be expected to have tried and failed multiple alternative medications first.

“As a result, many of those affected are now being seen through the not-for-profit clinic run by our charity instead, which has grown from three to 17 doctors in the past few years to accommodate the explosion in demand generated by the new medications and the obstacles to NHS care.”

Tickle said that for most people, assuming they can access treatment, anti-CGRPs will result in both a significant reduction in the number of migraine days and the severity of attacks.

He added: “We are repeatedly told by patients that finally, after years of trying to find the right medication, they once more have ‘a life worth living’.”

Helen Knight, director of medicines evaluation at NICE, underscored the significance of this development.

Prioritising patient care

She said: “Yesterday's final draft guidance demonstrates our commitment to prioritising patient care while ensuring fiscal responsibility,” she said.

Knight elaborated on the challenges faced by chronic migraine sufferers, she said: “For individuals who have exhausted three preventive treatments, injectable drugs have been the primary recourse.

“However, some patients cannot tolerate injectables due to allergies or needle phobia. Atogepant offers a much-needed oral alternative, providing increased choice for both chronic and episodic migraine patients.”

Health Minister, Andrew Stephenson, expressed his optimism about the potential of atogepant to alleviate the burden of migraines. “Migraines impact millions of lives in this country, and this new treatment will offer relief to those whose daily routines are disrupted by recurring attacks,” he said.

With its endorsement by NICE, atogepant emerges as a beacon of hope for migraine sufferers, promising improved management of this debilitating condition and a renewed sense of control over their lives.

Rob Music is chief executive at The Migraine Trust and told OSP that migraine is becoming better understood. He said: “Subsequently we are seeing more funding going toward research and development of treatments.

“It's this increased focus that led to development of the anti CGRP medications. Prospects are certainly improving for people living with migraine and news of additional treatments becoming available is a positive step forward. However, often access to newer medications has presented a barrier. We now need to ensure access to the newer treatments is swift, so that migraine patients can benefit from them.”