Cheap migraine medications worked just as well as more expensive ones

Half of the world's population struggles with headaches, and migraines are the biggest cause of disability for people under the age of 50, according to this sciencenorway.no article.

Head pain is not the only inhibiting effect. Migraines can also cause nausea, vomiting, and sensitivity to light and sound.

Young people are particularly vulnerable. A survey by Statistics Norway last year shows that half of young women in Norway struggle with headaches or migraines.

For many patients, the new CGRP inhibitors for migraines has given them their lives back. But this medicine is also very costly.

Do any other less expensive medicines work just as well?

This is what researchers at the Norwegian Centre for Headache Research (NorHEAD) set out to investigate. They used data from the Norwegian Prescription Database and in this way looked at which medicines best prevent migraines for people in Norway.

Acute and preventive treatment

In total, over 100,000 migraine patients were included in the study, which included figures from 2010 to 2020.

The researchers measured the effect of various medicines by looking at the use of acute migraine medicines both before and after the start of preventive treatment.

Acute migraine medications are ones that should be used when you first have a migraine attack. These include pain relievers like Paracetamol, Ibuprofen, or Naproxen, or anti-nausea medications like Metoclopramide.

And then there are medications that are designed to have a preventive effect, which you take to prevent future migraine attacks.

These preventive drugs are what the researchers looked at in the new registry-based study.

Several were better than beta blockers

Beta blockers are often the drug of choice for preventing migraine attacks.

But the researchers found that three other medications in particular had a better preventive effect than beta blockers. These were CGRP inhibitors, Amitriptyline, and Simvastatin.

Only CGRP inhibitors have been developed specifically for chronic migraines. The other two are medications originally designed for depression, chronic pain, and high cholesterol.

Had small or good effects

The researchers concluded that the preventive medicines had a good effect if the patients who used them needed less acute migraine medication.

On the other hand, if the patients used the same amount of acute migraine medication, despite also being on preventive medication, the researchers concluded that the preventive drugs had little effect.

The expensive medication

The specially developed medication, CGRP inhibitors, is the most expensive option.

The new study shows that the other two medications have equally good treatment effects, while also being significantly cheaper.

“This may be of great significance both for the patient group and Norwegian health care," Marte-Helene Bjørk said in a press release. She is a professor at the University of Bergen and one of the researchers behind the new study.

In 2021, the total reimbursement expenses for CGRP inhibitors was equivalent to almost 49 million USD.

How will patients be impacted?

“Any studies that give us more information about the treatment of migraines is good news for patients,” Kjersti Grøtta Vetvik says.

She is a senior physician and researcher in the Department of Neurology at Akershus University Hospital. Like Bjørk, she is affiliated with the Norwegian Centre for Headache Research, which is behind the new report, but she has not participated in the study herself.

“Migraine is a very common disease in the population and although we already have a lot of good medicinal treatments, we aren’t yet able to treat everyone effectively,” Vetvik says. 

Cholesterol-lowering medicine has so far been little used against migraines, Vetvik notes.

She believes that a randomised controlled clinical trial is needed.

“If the results from a clinical study confirm the results from the registry study, we’ll have another treatment option available for patients,” Vetvik says. 

Prescribed by a neurologist

Today, CGRP inhibitors must be prescribed by a neurologist and not by a patient’s GP. The cheaper medications can be prescribed by a GP and are therefore more easily accessible to patients.

“In addition, the cheaper medications have been in use for many years, and doctors know more about their side effects and long-term effects than they do with newer medicines like CGRP,” Vetvik says. 

Why is it that medications originally intended for other conditions, like high cholesterol, work just as well as medications that have been specifically developed for chronic migraine?

“For years, migraines have been treated with medications that were actually developed to treat other diseases, such as medications for epilepsy, depression, and high blood pressure,” Vetvik says.

CGRP inhibitors are the first medications specifically designed to prevent migraines.

“The fact that medications for other conditions and with vastly different mechanisms of action are effective in treating migraines tells us both how complex the disease is and that the migraine population is a heterogeneous group,” she says. 

An important study

The new study compares the various treatments available for migraine patients. Very few studies have done this before, according to Vetvik.

“The study largely confirms our clinical impression of the effect and tolerance of the individual medications,” she says.

Vetvik notes that cholesterol-lowering medicine has not been used much as a migraine prevention treatment in the past. 

“This should therefore be looked at in more detail in a randomised controlled clinical trial. If this study confirms the findings from the registry study, it might also give us more insight into the disease mechanisms of migraine,” Vetvik says. 

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Translated by Ingrid P. Nuse

Read the Norwegian version of this article at forskning.no

Reference:

Bjørk et al. Comparative retention and effectiveness of migraine preventive treatments: A nationwide registry-based cohort study, European Journal of Neurology, vol. 31, 2023. DOI: 10.1111/ene.16062