We welcome today’s decision by the Scottish Medicines Consortium (SMC) to approve Rimegepant (Vydura) for use within the NHS in Scotland for the acute treatment of migraine. While we welcome this decision, we are disappointed that the SMC has rejected its use as a preventive medication to treat migraine.

The decision to approve it for the acute treatment of migraine is very important because a significant proportion of those seeking help from The Migraine Trust have medication overuse headache as a result of inadequate care and treatment of their migraine. Many also have an inadequate response, or contraindication, to the (best) most effective current acute treatment, the triptans.

Medication overuse headache

Rimegepant is one of a new class of migraine medication developed to treat migraine, 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 medication overuse headache.

Medication overuse headache is a significant problem for people with migraine. A survey of 1,800 people with migraine that we ran in 2019 found that migraine medication had caused medication overuse headache in a third of people (34%). We believe that Rimegepant is an important opportunity to help those who have medication overuse headache and prevent others from developing it.

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

People with cardiovascular disease will be able to take Rimegepant, 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. There are also a significant number of patients not responding to the current gold standard triptans. Such patients will benefit particularly from the SMC’s decision.