A new treatment option for migraine - if you can access it
This factsheet was produced by headache doctors and brings together the latest trusted advice and information on anti-CGRP treatment for migraine.
This new class of medication can improve symptoms for people with migraine, sometimes dramatically: as many as 50 to 60 per cent people with migraine could benefit. Anti-CGRPs represent an important step forward in the search for more effective treatments.
Unfortunately, anti-CGRP treatment for migraine remains difficult to access through the NHS, although by booking an appointment with a headache specialist at the National Migraine Centre, you could get a prescription much more quickly.
The National Migraine Centre provides appointments with expert clinicians who can discuss access to anti-CGRP injectable medication, including Aimovig, Ajovy and Emgality, for people right across the UK.
You can also explore newer, tablet-based treatments, that are licensed both to prevent and treat migraine attacks – speak to a clinician about a prescription for Vydura (rimegepant). You can find out more and book an appointment here.
What is CGRP?
Calcitonin Gene-Related Peptide (CGRP) is an important chemical involved in transmitting pain signals through the nervous system – and it’s also associated with the triggering of migraine attacks.
It was first discovered in 1984 and has been studied extensively since.
CGRP is a type of protein that is produced by the body and when it builds up in the nervous system, it triggers receptors which open up the pain pathways and start the migraine attack. It is just one of the complex pain chemicals involved in the migraine mechanism.
What are anti-CGRP drugs?
Anti-CGRP injections are designed to stop the action of CGRP.
Injectable medications used in the prevention of migraine include Aimovig, Ajovy and Emgality, which are all available by prescription from headache specialists at the National Migraine Centre. These are known as monocolonal antibody medications (mAbs).
A newer group of oral, tablet-based anti-CGRPs, the gepants, is becoming available. The first to be licensed in the UK, Vydura (rimegepant), which can be used both to prevent and also to treat migraine attacks, is also now available via National Migraine Centre appointments.
For those who fail to see an improvement with other anti-CGRPs, a new treatment called Vyepti (eptinezumab) is also licensed. However, this is only available in hospital and is administered intravenously every three months.
Do anti-CGRP medications work for everyone?
They are effective in about 50 to 60 per cent of cases, but no single treatment will work for everyone with migraine.
In some cases, the improvement is dramatic and life changing. In others, it is not as effective but can still reduce the severity and frequency of migraine enough to make a difference to quality of life.
How do mAbs work?
MAbs work by targeting the CGRP peptide or its receptors, so blocking the neurochemical pain pathways involved in the migraine mechanism.
There are two types of these anti-CGRP drugs, which work in slightly different ways.
- Aimovig (erenumab) binds itself to the receptor.
- Ajovy (fremanezumab), Emgality (galcanezumab) and Vyepti (eptinezumab) all bind to the protein itself (the ligand).
These drugs have been studied over the last few years to see how safe and effective they are and have been licensed for use in the UK. Aimovig, Ajovy and Emgality, which can be administered by monthly injections at home, as well as the oral anti-CGRP Vydura, are all available on prescription. Vyepti is also available where other mAbs have failed, but must be administered by intravenous injection in hospital every three months.
Who are mABs suitable for?
They may be useful to anyone with episodic or chronic migraine, with or without aura, with certain exceptions. These drugs are unsuitable for the following groups (although note this list does not cover all exclusions – speak with a headache specialist to find out more):
- Those who are pregnant or planning to conceive (the recommendation is to stop them six months before trying to conceive)
- Those aged under 18 years
Some anti-CGRPS may be unsuitable for those with heart disease, so make sure to discuss this with your doctors.
What are the side effects of mAbs?
The most common reported side effects are stinging at the site of injection and constipation. Upper respiratory tract infections have been reported by some.
Although generally very well tolerated, you should discuss possible side effects with a headache specialist before proceeding.
How quickly do mAbs work?
If mAbs are going to help, they often start to work more quickly than other preventatives and may improve things even in the first month. We recommend trying an initial course of three months before judging how effective they are for you.
How long should mAbs be taken for?
The recommendation is to stay on them for a year and then review whether to continue or stop. The decision should be made in discussion with your headache specialist.
What if one medication does not work?
If one medication is not working, it’s possible to switch straight over to an alternative mAb – or to consider an oral anti-CGRP like Vydura instead (these tablets can be used both to treat as well as prevent migraine attacks).
If there have been side effects, the manufacturers advise a period of three to six months before trying a different mAb.
Vyepti, which is administered in hospital, may be considered by your doctor where other anti-CGRPs have failed.
Is anti-CGRP treatment for migraine available on the NHS?
The situation on NHS access to anti-CGRP treatment for migraine will vary depending on where you are in the UK. Each nation regulates access to medications differently and some medications may not be available everywhere.
If anti-CGRPs are available in your area, they cannot generally be prescribed by your GP. You will need to be referred to a specialist headache clinic or consultant neurologist.
Waiting lists for specialists can be very long indeed, and we hear from patients regularly about the difficulty in getting a referral at all or, when they have managed to do so, excessive waits of many months.
You are likely to find that you are unable even to be considered for anti-CGRP treatment for migraine until you can demonstrate that a range of other preventatives have been tried under supervision of a clinician, sometimes over the course of many months.
And after all that, some patients still find they are not being considered for prescriptions.
We believe all those who could benefit from anti-CGRPs deserve treatment on the NHS and we support advocacy to improve access for patients.
At the National Migraine Centre, we can provide you with quick and easy access to a clinician who is able to discuss with you prescribing anti-CGRP medication right away.
You can find out more about pricing for anti-CGRP medication here or go ahead and request an appointment now.
