Patients in the NHS may be prescribed a daily pill that reduces the frequency of their severe migraine headaches by 50%.

Migraine sufferers may soon have access to a groundbreaking daily pill on the NHS that could cut the frequency of their debilitating headaches in half. The National Institute for Health and Care Excellence (NICE), the NHS spending watchdog, is expected to make a decision later this month on whether to offer atogepant, the new drug, to patients who have not responded to other treatments. Studies have shown that atogepant, which costs approximately £8,000 per patient per year, is far more effective than another anti-migraine drug that was introduced by the NHS earlier this year.

Atogepant belongs to a class of medications called CGRP inhibitors, which work by blocking the effects of calcitonin gene-related peptide, a protein known to trigger migraines and their accompanying symptoms such as nausea. While CGRP injections have been approved for NHS use in recent years, there is a shortage of migraine specialists available to consult before these injections can be prescribed, resulting in long waiting lists. Atogepant, if approved, could be prescribed by general practitioners, improving accessibility for patients.

More than 5.6 million people in England are thought to have episodic migraines, which means they experience between four and 14 attacks a month

‘CGRP drugs have been game-changing, but there has been a huge backlog in getting prescriptions,” says Ria Bhola, a specialist migraine nurse working with The Migraine Trust charity. “Having a pill that can be obtained from a GP would make a significant difference.”

Approximately 5.6 million people in England suffer from episodic migraines, experiencing between four and 14 attacks per month. Most rely on painkillers or a class of prescription drugs known as triptans to manage the pain and reduce attack durations.

In March 2020, CGRP inhibitors were approved by the NHS as the first new migraine treatment in over two decades. There are currently three CGRP injections available on the NHS that can be self-administered monthly. However, The Mail on Sunday reported in 2021 that hundreds of eligible patients were paying up to £350 per month for private access to these medications due to the lack of availability on the NHS.

This ongoing issue is primarily attributed to a shortage of NHS resources. In May, NICE approved the first CGRP pill, rimegepant, for preventing migraines in patients who did not respond to existing treatments. Studies showed a reduction of two headache days per month with regular intake of the pill every other day. However, NHS Scotland regulators did not approve rimegepant for this purpose due to perceived insufficient benefits.

Most migraine sufferers rely on painkillers to dull the agony, or prescription drugs called triptans which can shorten the length of attacks

However, studies have shown that episodic migraine patients taking atogepant experience an average of four fewer headache days per month, making it nearly twice as effective as rimegepant. Participants in the trials, who had an average of eight migraines per month beforehand, saw a 50% reduction in the risk of experiencing these agonizing headaches.

Prof Peter Goadsby, the scientist who discovered CGRP in 1984 and director of the NIHR King’s College research facility, believes atogepant has the potential to “change the lives” of migraine sufferers. He explains that migraines not only cause excruciating pain but also disrupt daily activities due to their unpredictable nature. Patients who have tried various other medications without success have found relief with atogepant, experiencing fewer and less severe migraines. The side effects are minimal, with the main one being mild constipation, which can be alleviated with dietary adjustments.

With a year’s worth of treatment, migraines can potentially be controlled. In case of a relapse, patients can resume taking atogepant to manage the condition effectively.