NICE approves migraine medication Rimegepant for preventive use on the NHS in England

Unfortunately it has not been approved for acute use

31st May 2023

We welcome today’s announcement by the National Institute for Health and Care Excellence (NICE) that it will recommend new migraine medication Rimegepant (Vydura) for preventive use on the NHS in England. However, we are concerned that Rimegepant has not been approved for acute use too.

This is because acute use of this medication has potential to significantly help people with medication overuse headache and stop others from developing it. It would also provide an effective acute treatment for those who cannot take other acute treatments such as triptans.

Acute medications are taken during a migraine attack to treat the attack itself, while preventive medications are taken regularly to reduce the frequency and severity of attacks.

Medication overuse headache

Rimegepant, which is produced by Pfizer, is one of a new class of migraine medication developed to treat migraine acutely and as preventive medication, which are known as the gepants.

It is the first in this class to be appraised for use on the NHS. As opposed to conventional acute treatments such as triptans, non-steroidal anti-inflammatory drugs (NSAIDs), and other painkillers, the gepants don’t seem to cause rebound headache (medication overuse headache). Medication overuse headache is a significant problem for people with migraine.

Our 2019 survey of 1,800 people with migraine found that migraine medication had caused medication overuse headache in a third of people.

A safe migraine treatment for people with cardiovascular disease and those not responding to current migraine treatments

We are also concerned about people with cardiovascular disease, as unlike another class of acute migraine medication, the triptans, Rimegepant does not constrict or tighten blood vessels. This makes it a safe alternative to triptans for these patients.

There is also a significant number of patients who have not responded to the current gold standard acute migraine treatment, triptans. These patients will be disadvantaged by the decision.

NICE to meet again in August

NICE has said that the appraisal will be discussed at a further committee meeting on 10 August 2023. The Migraine Trust hopes that this will be a chance to change the decision and approve Rimegepant for acute treatment of migraine, particularly as the Scottish Medicines Consortium (SMC) recently approved Rimegepant for use within the NHS in Scotland for the acute treatment of migraine.

“Too many people with migraine end up with medication overuse headache as a result of their migraine treatment, which has a serious impact on their lives. This is an impact which is preventable if migraine is treated effectively.

“Gepants, the new class of migraine medication which Rimegepant is part of, can help prevent this happening. While we welcome that it has been approved for the preventive treatment of migraine, we are very disappointed by the decision not to approve it for the acute treatment of migraine.”

Rob Music, Chief Executive of The Migraine Trust