Norwegian study examines which drugs best prevent migraine

A migraine is more than just a headache. Often the pain is accompanied by nausea, vomiting, sensitivity to light and sensitivity to sound. Chronic migraine can be disabling and can prevent many, especially women, from contributing to working life.

However, 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 examine which medicines best prevent migraine in people in Norway:

A lot of research has now been done on this topic in the past. This may weaken the quality of treatment and increase the cost of treatment for this group of patients.”

Marte-Helen Bjørk, Principal Investigator, Professor, Department of Clinical Medicine, University of Bergen

Three drugs had a better effect than the first choice of drugs.

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

“When drug withdrawal for acute migraine was little changed after starting preventive medicine, or people quickly stopped preventive medicine, preventive medicine was interpreted as having little effect. reducing the consumption of acid drugs, we interpreted preventive medicine as a good effect,” explains Bjørk.

As a rule, so-called beta-blockers are used as the first choice to prevent migraine attacks, but the researchers found that three drugs in particular had a better preventive effect than them: 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 being developed and used specifically for chronic migraine,” says the professor.

It can have a big impact on health care costs.

CGRP inhibitors are more expensive than other drugs. In 2021 their compensation amounted to NOK 500 million (not including rebates given by pharmaceutical companies).

“Our analysis shows that some established and cheaper drugs can have a similar therapeutic effect to more expensive ones. This can be very important both for the patient group and for Norwegian healthcare,” says Bjørk.

Researchers at NorHead have already begun work on a large clinical study to measure the effect of established cholesterol-lowering drugs as a preventive measure against chronic and episodic migraine.