A new class of medications designed to prevent migraine attacks is offering life-changing relief to sufferers, but access to these treatments on the UK’s National Health Service (NHS) remains a significant challenge, with many patients experiencing years-long waits.

Migraine affects approximately ten million people in the UK, with women being three times more likely to experience it. The condition can be severely disabling, impacting daily life, work, and family commitments. For individuals like Joanne McShane, a 47-year-old health visitor, debilitating migraines led to frequent nausea, an inability to function, and a constant fear of the next attack.

Understanding Migraine and New Treatments

Migraine attacks are characterized by severe throbbing pain, nausea, and sensitivity to light and sound. These symptoms are often triggered by factors such as stress, fatigue, or skipped meals. During an attack, nerve cells release calcitonin gene-related peptide (CGRP), a protein that causes inflammation and overreaction in the brain's pain pathways. Women are particularly susceptible due to fluctuations in estrogen levels, which can make the brain's pain network more active.

Previously, treatments like triptans, amitriptyline, and topiramate were prescribed, but their effectiveness often waned, and they did not directly target the underlying mechanisms of migraine. Some patients resorted to injectable CGRP-blocking drugs, which typically require specialist prescription and involve long waiting times for referrals.

Breakthrough CGRP-Inhibiting Drugs

The advent of CGRP-inhibiting drugs, such as atogepant (brand name Aquipta) and rimegepant, has marked a significant advancement. Atogepant, approved in the UK in 2024, is the first daily tablet designed to prevent chronic migraine, a severe form defined by 15 or more headache days per month. It works by blocking the action of CGRP. Rimegepant, approved a year earlier, is for episodic migraine, affecting those with up to 14 attacks per month.

These drugs have demonstrated remarkable results, with many patients transitioning from frequent, debilitating attacks to being virtually migraine-free within weeks. Dr. Katy Kyprianou, a GP specializing in migraine, described the new medicines as “life-changing,” enabling patients to return to work and social activities.

Access Barriers and Inequities

Despite the clinical benefits, accessing these new treatments through the NHS is fraught with difficulties. In May 2024, the National Institute for Health and Care Excellence (NICE) recommended atogepant for adults with chronic or episodic migraine who have failed at least three older treatments. However, many patients are reportedly not informed about the drug or are incorrectly denied it.

Access often depends on a local NHS commissioning body's formulary, which uses a traffic-light system to dictate which drugs GPs can prescribe. In many areas, atogepant is classified as 'amber,' requiring specialist approval, or even 'red,' making it a hospital-only medication. This creates a postcode lottery, where patients in some regions can access the drug more easily from their GP, while others face extensive waits for specialist consultations.

Joanne McShane, for instance, faced a five-year wait for a neurologist assessment in her area of Northern Ireland to access Aquipta. She ultimately opted for private insurance to obtain immediate treatment, which has since rendered her virtually migraine-free for over a year.

Sylvia Hewitt, who has lived with migraines for nearly 40 years, also encountered a two-year NHS waiting list for CGRP-blocking drugs. She eventually received treatment through the National Migraine Centre, a charity offering reduced-cost options, describing the drug as an “absolute lifesaver.”

Underlying Causes of Delay

Experts point to several factors contributing to these access issues. Migraine has historically been