Rimegepant for preventing migraine

Outcomes

All patients in our primary care service who meet eligibility criteria for specialist migraine treatment can receive these treatments without the need for secondary care appointments. They are reviewed as per NICE guidelines after 3 months, and treatment is continued if it is sufficiently effective. All patients on injectable CGRP mAb treatments receive ongoing monitoring in a primary care service, saving further secondary care appointments. Follow up is with our nurse headache specialist, freeing up capacity within our service for GPwER diagnostic referrals, though the GPwER remains responsible for prescribing.

Learning

This case study demonstrates the ability to provide specialist migraine treatments in a primary care setting. However, it required collaboration and support from the integrated care board and the trust pharmacy and neurology services.

We learnt that it is easier to implement new treatment in primary care if prescribing does not require a commercial arrangement, and if electronic prescriptions are not precluded by the need for a wet signature.