Patients in England to be offered daily pill that can halve migraine frequency

Thousands of people in England who suffer from migraines are to be offered a daily pill on the NHS that can reduce the frequency of attacks by half.

In final draft guidance published on Thursday, the National Institute for Health and Care Excellence (Nice) has given the green light to the first oral treatment that can prevent both chronic and episodic migraines.

Atogepant – also called Aquipta and made by AbbVie – works by blocking the receptor of a protein found in the sensory nerves of the head and neck, known as calcitonin gene-related peptide (CGRP). CGRP makes blood vessels dilate, which can lead to inflammation and migraine.

The guidance is expected to give more choice to at least 170,000 patients in England, Nice said.

The regulator has recommended the drug as an option for preventing chronic and episodic migraines in adults who have had at least four migraine days a month and where at least three previous preventive treatments have failed.

Chronic migraine is where a person has at least 15 headache days a month, with at least eight of those having features of migraine. Episodic migraine is where a person has fewer than 15 headache days each month.

Helen Knight, the director of medicines evaluation at Nice, said: “Currently, the most effective options for people with chronic migraines who have already tried three preventive treatments are drugs that need to be injected.

“The committee heard from patient experts that some people cannot have injectable treatments, for example because they have an allergy or phobia of needles.”

Knight said patients with chronic migraines – that happen on more than 15 days of the month – “would welcome an oral treatment”.

She added that Aquipta also “offers more choice” for those who suffer episodic migraines, which happen on fewer than 15 days of the month.

Affecting about 4.5 million people in England, migraines can have a significant impact on a person’s daily life, as well as placing a heavy burden on the NHS and the wider economy.

Migraine charities called for “swift” access to the drug to ensure patients with the debilitating condition “can benefit from them as quickly as possible”.

The Migraine Trust chief executive, Rob Music, said: “A migraine attack can be incredibly debilitating. Symptoms can include intense head pain, loss of or changes to the senses, and lack of ability to carry out day-to-day life.

“It is positive to see even more therapies emerging for people with migraine as many still rely on treatments developed for other conditions.

“We now need to ensure access is swift, so that migraine patients can benefit from them as quickly as possible.”

The health minister Andrew Stephenson said: “Migraines affect millions of people in this country and this new treatment will help prevent recurring migraine attacks when other medicines have failed.

“It will allow more people whose daily life is affected by this painful, debilitating condition to manage their migraines more effectively and to live their lives to the fullest.”

Nice’s guidance for England comes after the pill was recommended for use in Scotland by the Scottish Medicines Consortium (SMC) in October last year.

Rachael Millward, medical director at AbbVie UK, said: “AbbVie has an extensive history in migraine research and is committed to addressing the unmet needs of people living with this debilitating condition.”

The recommendation from Nice means suitable people living with migraines will have access to an additional treatment option that has the potential to improve their quality of life, she added.

Nice recommends that Aquipta should be stopped after 12 weeks if chronic migraines do not reduce by at least 30% and episodic migraines by at least 50%.

If there are no appeals against its final draft guidance, Nice is expected to publish its final guidance on the drug in May.