Breakthrough NHS migraine medication 'Rimegepant' to provide hope to thousands in UK

The National Institute for Health and Care Excellence (Nice), the regulatory body for medicines, has given its endorsement for rimegepant, a new medicationby Pfizer, to be available on the NHS for thousands of migraine sufferers in England.This recommendation applies to approximately 145,000 adults who have experienced failure with at least three previous preventive treatments.

Rimegepant, first oral medication recommended for migraine

Migraine is a neurological disorder characterized by recurring moderate to severe headaches, often accompanied by other symptoms such as nausea, sensitivity to light and sound, and in some cases, visual disturbances. It is estimated that migraine affects over one billion people worldwide, making it one of the most prevalent and disabling conditions globally.

Rimegepant, also known as Vydura, is a convenient oral treatment that comes in the form of a dissolvable wafer, taken by placing it under the tongue.This marks the first time that Nice has recommended an oral medication specifically designed to prevent migraines.

Helen Knight, the director of medicines evaluation at Nice, emphasized the impact of migraines on individuals' lives, stating, “Each year the lives of millions of people in England are blighted by migraine attacks."

“They can be extremely debilitating and can significantly affect a person’s quality of life. Rimegepant is the first oral treatment for migraine to be recommended by Nice and for many thousands of people it is likely to be a welcome and more convenient addition to existing options for a condition that is often overlooked and undertreated," Knight added, as per media reports.

Nice's approval pertains to the use of rimegepant in preventing episodic migraines, which occur in individuals experiencing fewer than 15 migraine days per month.The draft guidance recommends rimegepant for adults who suffer from at least four migraine attacks per month but fewer than 15.

England Migraine data

In England alone, it is estimated that around 5.6 million people experience episodic migraines, with approximately 190,000 migraine attacks occurring daily.

Rimegepant works by blocking a protein called calcitonin gene-related peptide (CGRP) around the brain, preventing it from binding to its targets.CGRP is responsible for causing intense inflammation and the severe pain associated with migraine attacks.

Current treatment options

Treatment for migraines typically involves a combination of acute and preventive approaches. Currently, treatment options for preventing migraines include medications typically used for other conditions, such as beta-blockers, antidepressants, and epilepsy medications. However, these options may have significant side effects and may not be effective for everyone.

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After the failure of these treatments, Nice-recommended alternatives include erenumab, fremanezumab, or galcanezumab, all of which are administered through injections. Although Nice's endorsement of rimegepant for preventive treatment has been welcomed by charities, they expressed disappointment that the medicationhas not been approved for acute cases of migraines as well.

Rob Music, the chief executive of the Migraine Trust, stressed the importance of effective treatment to prevent medication overuse headaches, a common consequence of migraine treatment.

Music stated, “Gepants, the new class of migraine medication which Rimegepant is part of, can help prevent this happening. While we welcome 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.”

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