Title: Erenumab for treating migraine [ID1188]
Funder: Department of Health and Social Care

Abstract: To appraise the clinical and cost effectiveness of erenumab within its marketing authorisation for preventing migraine.

Lay abstract: Migraine is primarily a headache disorder manifesting as recurring attacks usually lasting for 4–72 hours involving throbbing head pain of moderate to severe intensity. It is often accompanied by nausea, sometimes vomiting, sensitivity to light, sensitivity to sound, and/or other sensory stimuli. Migraine can have a significant impact on quality of life and ability to carry out normal activities. Some people can have warning symptoms called an aura, before the start of a headache. Factors that can trigger attacks in people susceptible to migraines include stress, change in sleep pattern, overtiredness, menstruation, consumption of caffeine or alcohol, climatic conditions and use of visual display units. Migraine is on a continuum, and it is possible for people to move between episodic and chronic migraine: • Episodic migraine is defined as the occurrence of headaches on less than 15 days per month. • Chronic migraine is defined by the International Headache Society as the occurrence of headaches on 15 days or more per month for at least 3 months where the attacks fulfil criteria for pain and associated symptoms of migraine without aura on at least 8 days per month for at least 3 months, where there is no medication overuse, and where the headaches are not attributable to another causative disorder. A person must previously have had at least 5 attacks fulfilling the International Headache Society’s criteria for migraine with or without aura. It is estimated that there are 190,000 migraine attacks experienced every day in England.(1) Prevalence has been reported to be 5–25% in women and 2– 10% in men.(1) There are 3 broad approaches to managing migraine: lifestyle and trigger management, acute treatments and preventive (prophylactic) treatments. Preventive treatment of migraines can take many forms including nutritional supplements, lifestyle alterations such as increased exercise and avoidance of migraine triggers, and prophylactic migraine medications. It can also medications, which are generally considered for people who have at least 2 attacks a month, whose attacks are increasing in frequency, whose attacks cause significant disability despite abortive treatment, or who cannot take abortive treatment for migraine attacks. NICE clinical guideline 150 recommends offering topiramate or propranolol, and considering amitriptyline, for the prophylactic treatment of migraine according to the person's preference, comorbidities and risk of adverse events. NICE technology appraisal guidance 260 recommends botulinum toxin type A for the prophylaxis of headaches in adults with chronic migraine that has not responded to at least 3 prior pharmacological prophylaxis therapies and whose condition is appropriately managed for medication overuse. References 1. Steiner TJ et al. The prevalence and disability burden of adult migraine in England and their relationships to age, gender and ethnicity. Cephalalgia. 2003;23(7):519-527.

Research activity codes: 6.1 PHARMACEUTICALS
Health categories: NEUROLOGICAL