NICE has rejected migraine medication Rimegepant for use on the NHS in England

We are very concerned about the unnecessary suffering of people with medication overuse headache and those without effective treatment for their migraine

21st February 2023

We are very concerned about people in the UK with medication overuse headache, those with migraine who are at risk of developing it, and people who can’t use the currently available acute migraine medication.

We are raising our concern following today’s announcement by the National Institute for Health and Care Excellence (NICE) that it is not recommending Rimegepant for use within the NHS in England for the treatment of migraine.

A significant proportion of those seeking help from The Migraine Trust have an inadequate response, or contraindication to the best current acute treatment triptans, or have medication overuse headache as a result of inadequate care and treatment of their migraine.

We believe that Rimegepant is an important opportunity to help those who have medication overuse headache and prevent others from developing it.

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, it does not constrict or tighten blood vessels. This makes it a safe alternative to triptans in treating migraine acutely.

Moreover, the application to NICE was for preventive and acute treatment, however, for acute treatment, there are a significant number of patients not responding to the current gold standard triptans. Such patients will be specifically disadvantaged by the decision.

Public consultation following NICE decision

NICE has said that this rejection is not final, but an initial recommendation made in an Appraisal Consultation Document (ACD). Members of the public can take part in this consultation and submit their comments through a link on the NICE website.

“Unfortunately, very high numbers of people with migraine end up with medication overuse headache as a result of their migraine treatment. Medication overuse headache is a dull constant headache that is present on most days or a part of every day, which has a serious impact on the lives of those who develop it. It means that they rarely have a pain free day, and have to try and get on with their lives, work, study, have relationships and families, do the things they enjoy, all while dealing with daily pain. Gepants, the new class of migraine medication which Rimegepant is part of, offers a crucial opportunity to prevent this happening, and adding to the pain that people with migraine already experience. We are very disappointed by this decision and urge those affected by migraine, and particularly those without an effective treatment for migraine and who have experienced medication overuse headache, to respond to NICE’s consultation and let it know how much this new treatment option is needed.”

Rob Music, Chief Executive of The Migraine Trust