NICE approves atogepant for acute treatment of migraine on the NHS in England
Atogepant is now approved for acute as well as preventive treatment of migraine on the NHS in England.
Today the National Institute of Health and Care Excellence (NICE) announced that atogepant (Aquipta) has been approved for use as an acute treatment in England. An acute treatment for migraine is taken when a migraine attack happens, to relieve symptoms.
Atogepant (Aquipta) is part of a newer class of medication developed specifically for the treatment of migraine called gepants, also known as calcitonin gene-related peptide (CGRP) receptor antagonists. These medicines work by blocking the effect of CGRP, a chemical which is associated with migraine attacks.
Until today, atogepant was approved for preventive use in migraine treatment only. It has been prescribed to patients by NHS England since 2024 to reduce the frequency and severity of migraine attacks.
The availability of atogepant as an acute treatment, taken only during a migraine attack to treat symptoms, provides a much-needed alternative for people who have not had success with or aren’t able to tolerate other medications. Gepants are also less likely to cause medication overuse headache than other available acute treatments, making this an important new treatment option alongside rimegepant for people requiring frequent acute treatment.
With the exception of the more recently available CGRP monoclonal antibodies (CGRP mAbs), many of the other existing acute and 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 know that people living with migraine respond differently to different treatments and advocate for easy access to a wide variety of medicines within primary (e.g. GPs) and secondary (e.g. specialist headache clinics) care settings.
"Access to appropriate care for people with migraine can be seriously inconsistent, creating a postcode lottery. Many people with migraine tell us they have struggled to access treatments or had to wait a long time before they could see a specialist. This is concerning because those living with migraine typically try a number of medicines before finding what works best for them. That is why it is so important that there are a variety of treatments available and clinicians have clear guidance on how they should be prescribed. We therefore welcome today's update from NICE, which adds an additional treatment option for eligible migraine patients.
“We now need to ensure access to this treatment for acute use is swift and consistently applied in both primary and secondary care, so that migraine patients can access them as easily as possible.”
According to the latest NICE guidance, atogepant can be prescribed as an option for the acute treatment of migraine with or without aura in adults only if, for previous migraine attacks, at least two triptans were tried and they did not work well enough or were not tolerated and nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol were tried but did not work well enough.
Whether atogepant can be prescribed for the acute treatment of migraine in both primary and secondary care settings will be subject to local commissioning through Integrated Care Boards. This means that GPs may be able to prescribe atogepant as an acute treatment or they may need to refer to a specialist for a patient to gain access, depending on where they are based.
While the availability of atogepant for acute treatment 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 CGRP mAbs, only 52% had been offered access to this treatment. Those unable to access it 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.
Alice, who lives with chronic migraine, welcomes today’s announcement. She also believes that access to medications such as atogepant at an earlier stage would make a considerable difference for people living with migraine.
Alice said:
“I lost years of my life waiting to be taken seriously by medical professionals and waiting to access migraine-specific treatments. If a wider range of migraine-specific treatments, such as atogepant, were available earlier in the patient journey, I believe many people could reach effective treatment sooner, avoid years of unnecessary suffering, reduce their exposure to ineffective medications and side effects, and maintain a better quality of life. “
Similarly, Lisa, who has struggled to access migraine treatment, is clear that access to migraine-specific medications as acute treatment options is a step forward:
“You must try so many different treatments and face the side effects, then at times the waiting list for neurology has been nine months long. I do understand you can’t give out treatments to everyone straight away, but it’s a lot to deal with.”
