According to the latest NICE guidance, atogepant can be prescribed as an option for the acute treatment of migraine with or without aura in adults only if, for previous migraine attacks, at least two triptans were tried and they did not work well enough or were not tolerated and nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol were tried but did not work well enough.
Whether atogepant can be prescribed for the acute treatment of migraine in both primary and secondary care settings will be subject to local commissioning through Integrated Care Boards. This means that GPs may be able to prescribe atogepant as an acute treatment or they may need to refer to a specialist for a patient to gain access, depending on where they are based.
While the availability of atogepant for acute treatment is a positive step forward in improving migraine care, we are also aware of the difficulties that people experience in accessing these much-needed medications. Research for The Migraine Trust’s 2023 report, Heading in the Wrong Direction, found that among people who reported themselves to have met the eligibility criteria for CGRP mAbs, only 52% had been offered access to this treatment. Those unable to access it reported being told that their GP, neurologist or the local NHS does not prescribe it, that there was a lack of funds available to prescribe it, or that waiting lists are too long so clinicians were opting not to prescribe.
Alice, who lives with chronic migraine, welcomes today’s announcement. She also believes that access to medications such as atogepant at an earlier stage would make a considerable difference for people living with migraine.
Alice said:
“I lost years of my life waiting to be taken seriously by medical professionals and waiting to access migraine-specific treatments. If a wider range of migraine-specific treatments, such as atogepant, were available earlier in the patient journey, I believe many people could reach effective treatment sooner, avoid years of unnecessary suffering, reduce their exposure to ineffective medications and side effects, and maintain a better quality of life. “
Similarly, Lisa, who has struggled to access migraine treatment, is clear that access to migraine-specific medications as acute treatment options is a step forward:
“You must try so many different treatments and face the side effects, then at times the waiting list for neurology has been nine months long. I do understand you can’t give out treatments to everyone straight away, but it’s a lot to deal with.”
