One in seven of us suffer from Migraines, which can be hugely debilitating. Migraines not only have a physical impact on a patient but also a social, professional, and psychological one. They are commonly under-diagnosed and under-treated.
In addition to a headache, many patients can experience associated symptoms such as changes to their vision, speech disturbances, dizziness, or general skin numbness.
Migraines are a complex condition and are generally best managed through lifestyle advice and medication taking a bespoke and holistic approach with each patient.
There are various options in terms of medications for migraines, all of which have been available for a long time. Recently, a new medication has been licenced, which migraine sufferers may be interested in, called Rimegepant (brand name Vydura).
What is Rimegepant?
Rimegepant (Vydura) is a new medication which can be used as needed to treat the acute onset of migraines or taken regularly to prevent them.
How does Rimegepant work?
Migraines are thought to be caused by the release of the protein calcitonin gene-related peptide, which builds up around the brain. Rimegepant works to stop the release of this protein and thus help reduce the migraine symptoms, ideally within a few hours.
Who is this medicine for?
This drug, which is made by Pfizer, has been approved by NICE (National Institute of Clinical Excellence) for patients who have sudden onset migraines with or without an aura (associated neurological symptoms). It is suitable if one of the following criteria apply:
- The patient has previously tried 2 different types of the current migraine medication known as triptans and hasn’t responded favourably to it.
- Where triptans were contraindicated/not tolerated, and alternative medications such as anti-inflammatories, Aspirin or Paracetamol haven’t helped resolve the symptoms. (Triptans are not suitable for patients who have heart conditions or uncontrolled high blood pressure).
If you are having between 4 and 15 migraine attacks a month, then we would recommend you discuss preventative medication with us. If you have already tried 3 different preventative medications, then Rimegepant can be used to help.
How is Rimegepant taken?
For an acute migraine
The tablet is placed under the tongue to dissolve, and it takes up to 90 minutes for it to be fully effective.
One 75mg tablet is taken with the acute migraine with or without meals and if this fails to work a second tablet can be taken the following day. Treatment is deemed ineffective if the medication fails to resolve the migraine on 3 separate occasions.
As a preventative treatment
If used as a preventative treatment, the patient would take one 75mg tablet every other day. It is deemed effective if it reduces headache frequency by 50%.
Does Rimegepant work?
Yes, for many people. There is good evidence to suggest that the medication is likely to reduce migraine symptoms within 2 hours.
What are the potential side effects of Rimegepant?
The most common side effect is nausea. Rarely, patients can develop a hypersensitivity reaction (rash or shortness of breath), which can occur up to a few days after taking the medication. Should this happen, please do consult us straight away.
Who cannot take Rimegepant?
There are some patients who won’t be eligible for the medication.
It is advised to avoid if you are pregnant and consult with your doctor if breast-feeding due to limited data available.
There are some interactions with certain medications so during your assessment here at Sloane Street Surgery, we will review the other medications you are taking to make sure it is safe to prescribe.
Rimegepant isn’t suitable if you have severe liver disease or end-stage kidney disease, and currently, it is not used for under 18s as no research data is available.
There is also limited data with patients over 65 years, so do consult us to discuss further.
Find out more
If you suffer from migraines and want to discuss the various treatment options available to you, as well as Rimegepant, please get in touch, and any of the doctors in the surgery will be more than happy to go through it.