1 Recommendations

1.1 Rimegepant is recommended as an option for the acute treatment of migraine with or without aura in adults, only if for previous migraines:

at least 2 triptans were tried and they did not work well enough or
triptans were contraindicated or not tolerated, and nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol were tried but did not work well enough.

1.2 This recommendation is not intended to affect treatment with rimegepant that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.

Why the committee made these recommendations

The company proposed rimegepant for acute treatment after at least 2 triptans have not worked well enough, or if people cannot have triptans (contraindicated or not tolerated), which is narrower than the marketing authorisation.

Clinical trial evidence for acute migraine shows that rimegepant is more likely to reduce pain at 2 hours than placebo.

The most likely cost-effectiveness estimates are below or within what NICE considers to be an acceptable use of NHS resources. So, rimegepant is recommended.