Today the National Institute of Health and Care Excellence (NICE) announced that Atogepant (Aquipta) has been approved for use as a preventive medication in the treatment of migraine in England.  

Preventive medications are taken regularly to reduce the frequency and severity of migraine attacks. 

This announcement is the latest in a series of approvals of a newer class of medication, developed specifically for the treatment of migraine; the gepants. Last year, Rimegepant received approval from the relevant health bodies for preventive use in each of the UK nations, and for acute use in England, Scotland and Wales. Atogepant had also been approved as a preventive treatment in Scotland by the Scottish Medicines Consortium in October 2023.  

The availability of gepants provides much-needed alternatives for people who have not had success with other preventive medications, as well as those who have been impacted by medication overuse headache. With the exception of the more recently available Calcitonin Genere-related Peptide monoclonal antibodies (CGRP mAbs), many of the other existing preventive treatments currently in use have not been created specifically for migraine, and for many people, challenging side effects can impact their experience of these medications. We therefore welcome the addition of Atogepant as a preventive developed for migraine.     

NICE outlines the eligibility criteria for accessing Atogepant through secondary care as a preventive migraine treatment of migraine in adults, indicating it may be an option for preventing chronic and episodic migraines in adults who have had at least four migraine days per month and where at least three previous preventive treatments have failed. 

It’s worth noting that today’s final draft guidance issued by NICE marks the next step toward Atogepant becoming available; prescribing clinicians will have up to three months to make treatments available once final approvals are received, and local guidance can impact on whether particular medications are prescribed at all. 

While the availability of these newer classes of migraine medication is a positive step forward in improving migraine care, we are also aware of the difficulties that people experience in accessing these much-needed medications. Research for The Migraine Trust’s 2023 report, Heading in the Wrong Direction, found that among people who reported themselves to have met the eligibility criteria for another class of more recently approved treatments, CGRP mAbs found that only 52% had been offered access to CGRP mAb treatment. Those unable to access reported being told that their GP, neurologist or the local NHS does not prescribe it; that there was a lack of funds available to prescribe it; or that waiting lists are too long so clinicians were opting not to prescribe. 

Deborah, who lives with chronic migraine, feels today’s announcement is encouraging, but has also experienced considerable barriers in accessing newer migraine treatments: 

“For someone who has lived with severe migraine for over 40 years and for whom no treatment has ever worked, the innovation of gepants has brought me hope and life-changing relief. Having lost two careers to migraine, this new generation of migraine treatment has meant I am now able to return to work. 

Considering how disabling migraine can be and the cost of the condition both to the individual and to society, equitable, fair and timely access to the most appropriate, most effective treatment available is surely something each migraine patient deserves.”