Migraine is more than just a headache. Often the pain is accompanied by nausea, vomiting, light sensitivity and sound sensitivity. Chronic migraines can be disabling and prevent many, especially women, from contributing to their careers.
Still, it often takes a long time for migraine sufferers to find a treatment that works well for them. Researchers at the Norwegian Center for Headache Research (NorHead) used data from the Norwegian Prescription Register to see which drugs best prevent migraines in people in Norway:
There have been many studies on this topic before. This may undermine the quality of treatment and increase the cost of treatment for this patient group.”
Marte-Helen Björk, Study Leader, Professor, Department of Clinical Medicine, University of Bergen
All three drugs had a better effect than the first-choice drug.
The researchers used national registry data from 2010 to 2020 to estimate treatment effects. They measured this by looking at acute migraine medication intake before and after starting preventive treatment, and investigated how long people with migraine used different preventive treatments. A total of over 100,000 migraine patients were included in the study.
“When withdrawal of acute migraine medications changed little after starting preventive medication, or people stopped preventive medication quickly, preventive medication was interpreted as having little effect. If preventive medication was used for a long, uninterrupted period, and we saw Reducing the use of acute medication, we interpreted the preventive medication as a good effect,” Bjork explained.
As a rule, so-called beta blockers are used as the first choice to prevent migraine attacks, but researchers have found that three drugs in particular have better preventive effects: CGRP inhibitors, amitriptyline and simvastatin.
“The latter two drugs are also established drugs used for depression, chronic pain and high cholesterol respectively, while CGRP inhibitors are developed and used specifically for chronic migraines,” the professor said.
This can have great implications for health care costs.
CGRP inhibitors are more expensive than other drugs. Their reimbursement amount in 2021 was NOK 500 million (including rebates from pharma companies).
“Our analysis shows that some established and cheaper drugs can have the same treatment effect as more expensive drugs. This could be significant both for the patient group and for Norwegian healthcare,” says Björk.
Norhead researchers have already begun work on a large clinical study to measure the effects of established cholesterol-lowering drugs as preventive measures against chronic and episodic migraine.
Bjork, MH, etc. (2023). Comparative retention and effectiveness of migraine preventive treatments: a nationwide registry-based cohort study. European Journal of Neurology. doi.org/10.1111/ene.16062.