First in new class of treatment for acute migraine recommended by NICE set to benefit thousands

The first in a new class of treatment to be recommended by NICE for treating acute migraine will soon be available on the NHS to around 13,000 people.

NICE has today (14 September 2023) published final draft guidance recommending rimegepant as a cost-effective option for the acute treatment of migraine in adults. NICE has previously recommended treatments, including rimegepant, for preventing migraine in adults.

The draft guidance recommends rimegepant (also called Vydura and made by Pfizer) for adults who have tried at least 2 triptans - a group of medicines used to treat migraine or headache - but they didn’t work well enough.

Rimegepant is also recommended for adults who can’t take triptans or they weren’t tolerated, and nonsteroidal anti-inflammatory drugs (such as ibuprofen and aspirin) and paracetamol were tried but didn’t work well enough.

The clinical trial evidence shows that rimegepant is more likely to reduce pain at 2 hours than a dummy drug.

Rimegepant works by stopping the release of a protein around the brain called calcitonin gene-related peptide that is believed to be responsible for the severe pain associated with migraine attacks.

Currently, when triptans are ineffective, not tolerated, or contraindicated, there is no further standard treatment and people are advised to see a migraine specialist. But there are a limited number of headache centres in the UK and there are long waiting lists.

Helen Knight, director of medicines evaluation at NICE, said: “This is the first of a new class of medicine to be recommended by NICE that can help alleviate the misery of acute migraines, and may be considered a step-change in treatment.

“Migraine is a condition described in comments to NICE from carers and people with migraine as an invisible disability that affects all aspects of life including work, education, finances, mental health, social activities, and family.

“Today’s final draft guidance addresses the high unmet need for treatment options for acute migraine, once again demonstrating our ability to ensure clinically and cost-effective medicines are available to those who need them as quickly as possible.”

NICE expects to publish its final recommendations on rimegepant in October.

This is the first of a new class of medicine to be recommended by NICE that can help alleviate the misery of acute migraines, and may be considered a step-change in treatment.

Helen Knight, director of medicines evaluation at NICE