Thousands of migraine sufferers could find relief after being told they can have a pain-busting wonder drug on the NHS.
Doctors in England and Wales have been given the thumbs-up to increase the use of fremanezumab – a monthly jab into the arm, tummy or leg.
The drug belongs to a class of medicines called CGRP inhibitors, which have transformed migraine therapy in the past few years and been hailed by some experts as the biggest breakthrough in treatment of the condition since the 1980s.
But the drugs have until now been restricted to those with chronic migraines – defined as at least 15 days of excruciating attacks every month.
Anyone reporting less than that, known as episodic migraine sufferers, did not qualify.
Doctors in Scotland already had the go-ahead in 2020, while Northern Ireland has not yet made an announcement.
Now the National Institute for Health and Care Excellence (NICE) has ruled patients who suffer on at least four days in a month or more can also get the jab, potentially helping many more every year.
Leading UK headache experts welcomed the approval, predicting that it will give many patients back a normal life.
Doctors in England and Wales have been given the thumbs-up to increase the use of fremanezumab – a monthly jab into the arm, tummy or leg
Mystery of foreign accent syndrome
Michelle Myers (pictured), from Arizona, woke up one day in 2018 with a ‘Mary Poppins-style’ British accent
Imagine waking up with a strong German accent – despite, er, not being German at all.
Foreign accent syndrome, as it is known, has baffled medics for decades.
Brain damage – commonly stroke – can change the pitch, intonation and timing of a patient’s speech, causing them to unintentionally take on a foreign accent.
Examples include an Australian woman who developed a French accent after suffering brain damage in a car accident, and Michelle Myers, above, from Arizona, who woke up one day in 2018 with a ‘Mary Poppins-style’ British accent after falling asleep the night before with a headache.
Most cases resolve in time, and speech therapy can ease symptoms.
‘These drugs are life-changing,’ says Dr Mark Weatherall, consultant neurologist at Buckinghamshire Healthcare NHS Trust.
‘I’ve had patients who have not been able to work for years due to migraine attacks but who are able to return to their jobs after being put on this treatment.
‘The benefits to wider society from this are immense.
‘Many of those suffering from episodic migraines may be affected up to 14 days a month – just below the old threshold for the drugs.
‘Yet their lives are significantly debilitated.
‘So the NICE approval could have huge benefits for them.’
About seven million people in the UK suffer with migraines, with women three times as likely to get them as men, possibly as attacks are linked to the female hormone oestrogen.
The main symptom is an intense, one-sided headache but nausea and increased sensitivity to light and sound are also experienced.
Most patients rely on painkillers to dull the agony, or prescription drugs called triptans which can shorten the length of attacks.
For years, there was nothing that could prevent migraines or reduce their frequency.
Then, in March 2020, the NHS gave the green light to CGRP inhibitors to the most severely affected.
The drugs work by blocking a chemical called calcitonin gene-related peptide (CGRP), responsible for the pain and nausea associated with migraines – halving the number of attacks.
There are three anti-CGRP drugs approved for use in the UK – erenumab, galcanezumab and fremanezumab.
NICE’s decision means fremanezumab joins the two others in being approved for use in chronic and episodic migraine.
But, as with its two rivals, fremanezumab can be prescribed only when patients have failed to improve on at least three previous medications, such as painkillers, an anti-epilepsy drug called topiramate that doubles as a migraine therapy, or triptans.
Treating migraines has been a challenge for scientists, partly because the causes of attacks are still largely unclear, making it difficult to identify drugs that could help.
Some people have certain triggers, such as dark chocolate or caffeine, but that doesn’t mean they cause the migraines.
The Migraine Trust says the condition runs in families but no single gene is responsible. Instead it’s a combination of genes acting together.
What’s the difference between hypoglycaemia and hyperglycaemia?
Both refer to blood-sugar levels – the amount of glucose in the blood – and most commonly affect people with diabetes.
Hypoglycaemia occurs when blood-sugar falls too low, and needs to be treated quickly.
Symptoms include sweating, tiredness, a fast heartbeat and, in severe cases, seizures.
Hyperglycaemia – when blood-sugar is too high – develops over a few days or a week and causes thirst, a need to urinate frequently, tiredness and blurred vision.
Persistently high blood-sugar damages organs and raises the risk of heart attacks.
One patient who hopes to benefit is Nia Beynon, a 30-year-old publisher from Cardiff, who has endured about 12 migraine days a month since she was 13.
She says: ‘It’s a really intense pain. It can make me nauseous.’
Nia, who lives with her husband, has tried the preventative drug pizotifen and different beta-blockers, but found it difficult to remember to take a daily pill.
Nia now endures migraines for about an hour while the treatment sumatriptan kicks in, with her head then still too sensitive to touch.
Injectable fremanezumab would give Nia one thing fewer to think about – and until now she wasn’t eligible.
She says: ‘It would be a relief. I always have to have my tablets on me.’
Dr Weatherall said the NICE decision was ‘very good news’ but stressed that many patients are already struggling to access the life-changing injections, an issue The Mail on Sunday highlighted last summer.
The Migraine Trust estimates that only 1,000 out of the 200,000 or so patients who meet the criteria for anti-CGRPs get them on the NHS.
In a recent report, for which it contacted 128 NHS trusts in England, it found that just 13 provided specialist headache clinics and only 15 gave CGRP injections to those in need.
The Migraine Trust’s Rob Music said: ‘There is a postcode lottery of care, where only the lucky few can access a treatment which has proven transformational.
This should be such an exciting and positive time but lack of access is leading to continued poor health and deep frustration.’