Cheap vs Expensive: What Is the Best Medicine for Migraines?

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New research analyzing over 100,000 migraine patients, revealed that CGRP inhibitors, amitriptyline, and simvastatin are more effective than traditional beta-blockers in preventing migraines. This discovery could lead to more cost-effective treatments and impact healthcare spending in Norway.

A migraine is much more than a mere headache. It frequently involves additional symptoms like nausea, vomiting, and a heightened sensitivity to light and sound. Chronic migraines can be debilitating, often hindering individuals, particularly women, from fully participating in their professional lives.

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 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.

Three medicines had a better effect than the first choice of medicines

The researchers used national register data from 2010 to 2020 to estimate treatment effect. They measured this by looking at the consumption of acute migraine medicines before and after starting preventive treatment, and investigated how long the people with migraine used the different preventive treatments. A total of over one hundred thousand migraine patients were in the study.

“When the withdrawal of acute migraine medicines changed little after starting preventive medicines, or people stopped quickly on the preventive medicines, the preventive medicine was interpreted as having little effect. If the preventive medicine was used on long, uninterrupted periods, and we saw a decrease in the consumption of acute medicines, we interpreted the preventive medicine as having good effect,” Bjørk explains.

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 health care

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.

The researchers at NorHead have already started work on a large clinical study to measure the effect of established cholesterol-lowering medicines as a preventive measure against chronic and episodic migraine.

Reference: “Comparative retention and effectiveness of migraine preventive treatments: A nationwide registry-based cohort study” by Marte H. Bjørk, Solveig Borkenhagen, Francisco Oteiza, Aud N. Dueland, Frank E. Sørgaard, Erik Magnus Sæther and Christoffer Bugge, 27 September 2023, European Journal of Neurology.
DOI: 10.1111/ene.16062

The study was done in collaboration with Aud Nome Dueland (Headache Norway, Sandvika Neurocenter), Frank Sørgaard (former medical advisor at Novartis), and Solveig Borkenhagen with several from Oslo Economics. The results are published in the prestigious journal European Journal of Neurology.

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