Migraine sufferers in England may soon be able to access preventative drug – here’s how atogepant works

By Anna Andreou, King's College London

A drug that can help prevent migraines could soon be available on the NHS. Atogepant (brand name: Aquipta) was recently recommended by the National Institute for Health and Care Excellence (Nice) to prevent episodic and chronic migraine attacks. The drug would be recommended to people who have at least four migraine days a month or where at least three previous preventative treatments have failed.

Migraine is a complex neurological condition that affects about 10 million people in the UK. It’s characterised by recurrent, severe headaches that can be made worse by physical activity and are often debilitating. They’re accompanied by other neurological symptoms such as aura (usually vision disturbances, such as flashes or light or blind spots), sensitivity to light or sound, nausea and vomiting.

About 1% of the population suffer from chronic migraine attacks. This means they have 15 or more headaches days a month, with at least eight of these headaches having migraine characteristics. Both episodic and chronic migraine attacks have a significant effect on a person’s quality of life, as they may miss out on social activities and work.

Until now, the first options migraine patients had to prevent attacks was to use either blood pressure drugs or anticonvulsants. But many people prescribed these drugs for migraine attacks stop using them because they either aren’t effective or because of the side-effects they cause – such as dizziness, tiredness and slow speech.

But atogepant has been specifically developed to prevent migraines.

Atogepant belongs to a new group of drugs named gepants. More specifically, it is a calcitonin-gene related peptide (CGRP) receptor antagonist.

CGRP is a small protein that circulates at elevated levels during a migraine. People who have chronic migraine consistently have higher levels of CGRP in their system. It’s believed that CGRP is produced by neurons that provide sensory information to the head and neck. When CGRP activates the CGRP receptor, it’s thought to contribute towards the development of the migraine headache.

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