Erenumab (Aimovig) was licensed in the UK in July 2018 and NICE has been appraising the drug. Initial draft guidance in January 2019 said that the drug would not be a cost-effective use of NHS resources.

However, in May, following the large number of responses to the draft appraisal, NICE postponed the publication date of the Final Appraisal Document to consider a “new value proposition” and further evidence and evaluations.

The Scottish Medicines Consortium and Health Improvement Scotland have approved erenumab for use within NHS Scotland. Prescribing should be reserved for migraine prophylaxis in adults with chronic migraine who have at least four migraine days per month, and for whom at least three prior prophylactic treatments have failed.

The US Food and Drug Authority has been asked to consider approving galcanezumab (Emgality) for the prevention of episodic cluster headaches, having already authorised its use in migraine. The European Medicines Authority has approved the marketing authorisation for galcanezumab in the prevention of migraine in adults who have migraines at least 4 days a month, but the product has not been marketed here as yet.28,29

Similarly, fremanezumab (Ajovy) has launched in the US, and has received EMA approval in April 2019 “to prevent migraine in adults who have migraines at least 4 days a month” but has still to be launched here at the time of writing. It is also being studied for use in cluster headache.21,30

Eptinezumab is in late-stage clinical development. It works by selectively binding to the CGRP ligand with high affinity to block its effect at all CGRP receptors.31