A new study offers insight into what works best to prevent migraine attacks and unexpectedly, cheaper medications performed just as well as more expensive ones. Migraines are more than just headaches. Frequently, the discomfort is accompanied by nausea, vomiting, and light and sound sensitivity. Chronic migraines can be disabling, preventing many people, particularly women, from working.
Still, it often takes a long time for migraine patients to find a treatment that works well for them. Researchers at the Norwegian Center for Headache Research (NorHead) have used data from the Norwegian Prescription Register to look at which medicines best prevent migraine in people in Norway:
“There has now been done a lot of research on this subject before. This may weaken the quality of the treatment and increase the cost of treatment for this patient group,” says the leader of the study, Professor Marte-Helen Bjørk at the Department of Clinical Medicine, University of Bergen.
Our analysis shows that some established and cheaper medicines can have a similar treatment effect as the more expensive ones. This may be of great significance both for the patient group and Norwegian health care.
Professor Marte-Helen Bjørk
Three medicines had better effect than the first choice of medicines
The researchers analyzed national register data from 2010 to 2020 to evaluate the treatment effect. They examined this by examining the consumption of acute migraine medications before and after starting preventive treatment, as well as the length of time migraine patients used the various preventive treatments. The study included more than 100,000 migraine patients.
“When the withdrawal of acute migraine medications changed little after commencing preventative medications, or when persons stopped using them rapidly, the preventive medication was assessed as having minimal effect. Bjørk notes that if a preventative medicine was used for an extended length of time and there was a drop in the intake of acute medications, it was considered effective.
As a rule, so-called beta blockers are used as the first choice to prevent migraine attacks, but the researchers found that especially three medicines had better preventive effects than these: CGRP inhibitors, amitriptyline, and simvastatin.
“The latter two medicines are also established medicines used for depression, chronic pain, and high cholesterol, respectively, while CGRP inhibitors are developed and used specifically for chronic migraine,” says the professor.
Can have great significance for the cost of healthcare
CGRP inhibitors are more expensive than the other medicines. In 2021 their reimbursement amounted to 500 million NOK (not including discounts given by pharma companies).
“Our analysis shows that some established and cheaper medicines can have a similar treatment effect as the more expensive ones. This may be of great significance both for the patient group and Norwegian health care” says Bjørk.
NorHead researchers have already begun work on a big clinical trial to assess the efficacy of proven cholesterol-lowering medications as a preventive measure for chronic and episodic migraine.
Generic migraine drugs have been proved in research and clinical studies to be just as effective as their brand-name counterparts. Although the active ingredients in these prescriptions are same, generic drugs are often less expensive since they do not incur the same research and development or marketing costs as brand-name drugs.
