Joanne McShane’s migraines left her severely nauseous – once so badly she had to be sick into a bin at work.
The 47-year-old health visitor was in a work meeting when she was suddenly overwhelmed by a wave of nausea and stabbing head pain and couldn’t reach the loo in time.
‘The sickness just comes on,’ she says. ‘All you want to do is lie down in a dark room. You literally can do nothing. You cannot eat, you cannot sleep. You just put something cold on your head and hope it passes.’
Joanne has lived with migraine attacks for five years – at one stage she was having them every five days. Each could last up to three days. As soon as one eased, another often began. ‘Sometimes one literally goes into the other,’ she says. ‘You feel like it is starting to clear a little and then it just hits again.’ Every part of her life was affected. Driving became impossible because of the pain. Family plans – she has a 17-year-old daughter – often had to be abandoned at short notice.
‘It is not a quick headache that goes away,’ she says. ‘It really impacts everything. It’s very hard to plan things or to enjoy a normal life.’
She describes waking each day afraid another attack would strike: ‘It’s absolutely horrendous.’
But for Joanne, and millions like her, help has finally arrived.
A new generation of drugs specifically designed to block migraine before it starts is delivering results doctors are calling ‘life-changing’ – with many patients going from daily debilitating attacks to being virtually migraine-free within weeks.
But there’s a cruel twist: while these breakthrough treatments sit on pharmacy shelves, desperate patients across the UK are being forced to wait years to access them on the NHS.
Joanne McShane has lived with migraine attacks for five years. She had had already worked her way through six different drugs before hearing about Aquipta
Migraine affects ten million Britons and women are three times as likely to have migraine because sudden drops in levels of oestrogen make the brain’s pain network more active
Migraine affects around ten million people in the UK and often runs in families.
While there’s no single ‘migraine gene’, several are known to make nerve cells more sensitive to light, sound and movement.
This means the brain has a lower threshold for triggering a migraine when someone is stressed, tired or has skipped meals, because all three put extra strain on the brain’s energy supply and make the pain pathways activate sooner than normal.
During an attack, nerve cells release CGRP (calcitonin gene-related peptide), a protein that makes the pain circuits overreact and causes blood vessels in the brain’s lining to widen and become inflamed.
That combination produces the throbbing pain, nausea, light sensitivity and dizziness of a migraine.
Women are three times as likely as men to have migraine because sudden drops in levels of oestrogen – such as just before a period, after childbirth and during the perimenopause – make the brain’s pain network more active, says Dr Katy Munro, a GP at the National Migraine Centre, a UK charity that provides diagnosis and treatment.
Oestrogen helps dampen down the activity of the nerve cells involved in pain – when the hormone levels fall sharply, these cells fire more easily and release CGRP.
Joanne, from Belfast, had experienced occasional migraines earlier in life, but they became far more severe in her 40s, which she blames on the perimenopause.
For five years, as well as trying to manage her stress and eating regularly, she tried every treatment her GP could offer to control the pain. She began with triptans, drugs taken at the start of an attack which work by narrowing widened blood vessels in the brain.
When those were no longer enough after six months, her doctor prescribed amitriptyline, an antidepressant which can dampen pain circuits, and then topiramate – an anti-epileptic drug which helps stabilise nerve activity. She also needed anti-sickness tablets.
‘Everything worked for a couple of months, maybe six months at most – and then it stopped working,’ says Joanne. ‘I was running out of things to try.’
Indeed, none of these drugs targets the brain pathways that drive attacks and the body can adapt to them – so any benefit wears off.
By the summer of 2024, Joanne had already worked through six different drugs.
It was only then that she learned about atogepant (brand name Aquipta), the first daily tablet to prevent chronic migraine, the most severe form, in which patients have 15 or more headache days a month, often with no clear days at all – a level of suffering the World Health Organisation classes as a disability. It works by blocking CGRP, the chemical that drives the migraine process.
Injectable CGRP drugs exist, but they can be prescribed only by a specialist and patients face long waits – often years – for a referral. Atogepant, approved in 2024, was the first daily tablet that GPs could prescribe – potentially opening up access to many migraine sufferers stuck on long waiting lists or put off by painful injections.
(A similar drug, rimegepant, was approved the previous year – but only for episodic migraine, affecting those with up to 14 attacks a month.)
In May 2024, the National Institute for Health and Care Excellence (NICE) approved Aquipta for adults with chronic or episodic migraine who have already tried three older drugs. Around 170,000 people in England should qualify, according to NICE.
Yet many patients are never told the drug exists or are wrongly refused it.
Indeed, Joanne found that to receive it on the NHS where she lived in Northern Ireland, she would have to be assessed by a neurologist – and the waiting time for that in her area was an astonishing five years. And she’s not alone – getting access to these drugs is a widespread problem.
A spokesman for the charity the Migraine Trust said: ‘Our helpline receives dozens of enquiries each month from people who are struggling to access newer migraine medications so we know that access remains an issue.’
Part of the problem is that in many parts of the UK, integrated care services – the local bodies which decide spending on medicines – have classed Aquipta as ‘red’ or ‘amber’ on the traffic-light system that dictates who prescribes what drugs on the NHS. That means GPs cannot issue it and a patient must instead see a specialist.
In England, each local NHS commissioning body (known as integrated care boards, ICBs) uses a colour-coded traffic-light system to decide which medicines GPs can prescribe. A similar system is used in other parts of the UK.
Sylvia Hewitt had suffered from migraines for 40 years… after hearing about trials of Aquipta, she discovered there was a two-year wait on the NHS. She turned to the the National Migraine Centre charity and has now been treated. ‘It was an absolute lifesaver,’ she says
Under the traffic-light system – which applies to all medications – ‘green’ drugs can be prescribed freely in primary care; ‘amber’ drugs usually have to be started or approved by a specialist before a GP can continue them; and ‘red’ drugs are hospital only (eg doxorubicin, a chemotherapy drug to treat cancers of the bladder and breast; and clozapine, an anti-psychotic for schizophrenia).
The Mail investigated the state of prescribing Aquipta by checking all 42 ICB drug formulary websites (officially approved lists of pharmaceutical drugs and clinical guidelines) in the country to find out if they had labelled the drug red, amber or green.
Aquipta is classed as amber in many areas, such as Nottinghamshire, Leeds and Frimley (see graphic). In a few places, such as Surrey Heartlands, it is still classed as red, so remains a hospital-only drug.
Other regions, including Cheshire, Merseyside and parts of Suffolk, have now moved it to green – allowing GPs to prescribe it more freely once patients meet the NICE criteria for it.
And there are signs that things are changing.
In February this year, NICE reported a steep rise in GP prescribing of CGRP-targeting tablets, with nearly 23,000 people in England accessing them through their family doctor in 2025 – three times the level in 2024.
Joanne felt she couldn’t have lasted another five years – the time it would have taken to see a neurologist. ‘My mental health wouldn’t have survived’, she says.
Luckily, she’d previously taken out private health insurance (having seen how bad the NHS in her area was, she says). It meant she could see a neurologist almost immediately.
‘I would still be on that waiting list otherwise,’ she says.
Within weeks of starting Aquipta, Joanne’s attacks were under control. ‘I am scared to say this out loud, but I have not had a migraine attack in a year and a half,’ she says.
‘Now if I get an odd headache I take two paracetamol – and I am good to go. Before that, a migraine would have put me in bed for three days. Honestly, it is revolutionary.’
The lack of access to the drug can be blamed on the condition being ‘widely dismissed for years’, says Dr Munro, even though having more than ten migraine days a month meets the World Health Organisation’s threshold for a disability.
In a 2024 survey, the NMC found 60 per cent of people with migraine wait more than five years for effective treatment. Some wait more than ten years. It blames the delays on long waiting times at NHS headache clinics, as well as misdiagnosis.
Dr Munro says patients often ‘struggle along’ for years without a diagnosis – and that’s partly because ‘many GPs have almost no formal training in headache disorders’. ‘They get about an hour and a half’s teaching in their whole medical school training on headaches.’
Where GPs can prescribe Aquipta
Aquipta is a potentially life-changing new drug for people with migraine, the first daily pill made specifically to prevent it.
It’s meant to be offered to adults in England with chronic migraine who’ve already tried three older drugs. But many patients are missing out. So are you going to be able to get it?
In England, GPs can prescribe Aquipta – but as our unique map reveals, many local health authorities are limiting patients’ access.
‘Red’
Indicates that the drug is available only through a hospital, i.e., prescribed by a neurologist.
Surrey Heartlands; North East London; Derby & Derbyshire; North West London; South East London; South West London
‘Amber’
Indicates the drug must be started or approved by a specialist before a GP can continue prescribing it.
North Central London; Nottingham & Nottinghamshire; Frimley; Humber & North Yorkshire; South Yorkshire; Staffordshire & Stoke-on-Trent; Bedfordshire, Luton & Milton Keynes; Cambridgeshire & Peterborough; Dorset; Bath & North East Somerset, Swindon & Wiltshire; Coventry & Warwickshire; Herefordshire & Worcestershire; Hertfordshire and West Essex; Mid and South Essex (yellow); Leicester, Leicestershire & Rutland (yellow); Lincolnshire; Buckinghamshire, Oxfordshire & Berkshire West; Hampshire and Isle of Wight; Kent and Medway; Sussex; Bristol, North Somerset & South Gloucestershire; Gloucestershire (yellow); Somerset; West Yorkshire (specialist initiation)
‘Green’
Indicates areas where the drug can be prescribed freely.
Norfolk & Waveney; Suffolk & North East Essex; Birmingham & Solihull; Black Country; Greater Manchester; Northamptonshire; North East & North Cumbria; Shropshire, Telford and Wrekin; Cheshire and Merseyside; Lancashire and South Cumbria; Cornwall; Devon
Source: Local NHS prescribing lists, known as formularies.
The same National Migraine Centre survey found almost one in five migraine patients had previously been misdiagnosed by GPs, who wrongly blamed their symptoms on menopause, depression, chronic fatigue syndrome, sinusitis and iron deficiency.
But even with the right diagnosis, lack of understanding may mean that GPs aren’t offering the individual patient the best treatment for them, with distressing consequences.
As Dr Munro explains: ‘We have people who come in and say: “The impact of my migraine attacks is so bad I don’t want to live any more.”
‘Training and specialist knowledge means that many GPs still leave it up to a neurologist to prescribe Aquipta – even though they could prescribe it themselves. It’s a postcode lottery.’ (Cost isn’t an issue, the drug costs £463 for a 28-day supply, but the NHS gets a discount.)
She fears many patients are being left on older treatments that no longer work.
Added to this are funding cuts to community-based headache clinics, which employ specialist GPs who have the confidence to prescribe Aquipta without a referral to a neurologist.
‘Long-running GP-led headache clinics have been cut due to funding pressures,’ says Dr Munro.
‘One in Devon that had run for 30 years closed recently and its patients were transferred to overstretched neurology services.
‘In Wales there is only one GP with a recognised special interest in headache – which leaves thousands waiting for a referral.’
Specialist headache care is patchy across England, despite migraine affecting millions.
A 2023 Freedom of Information report by The Migraine Trust found that only 26 of the 42 local NHS commissioning bodies had a specialist headache clinic.
And there are fewer than 80 GPs across the UK with a recognised special interest in headache and migraine, the same report suggests.
Dr Katy Kyprianou, a GP who specialises in migraine in Birmingham, says the new medicines represent a major step forward. ‘I would call them life-changing,’ she says.
‘For the right patient they can reduce the number of attacks to allow them to work, see friends and play with their children again.’
Debbie Shipley, head of support at The Migraine Trust, says: ‘The impact that migraine can have on every area of life is huge – so the consequences of being denied treatment can be severe.’
Retired nursery worker Sylvia Hewitt, 71, from Hereford, knows this all too well.
She has lived with migraine for almost 40 years – she also used to vomit routinely during severe attacks.
The rate of attacks crept up to 12 or 15 a month over many years, but accelerated 15 years ago as a result of the menopause, lasting up to three days at a time. Some months she had no completely clear days at all.
‘My mother would ring to see how I was and I’d be crying down the phone saying I don’t know if I can go on,’ says Sylvia.
Nearly 20 years ago she read a small newspaper article about the first trial of a drug that blocked CGRP that ‘felt like a real breakthrough’, she recalls.
Desperate, she cut the article out and pinned it to her bedroom wall – and waited.
Two decades later, when CGRP-blocking drugs finally became available, she discovered the NHS waiting list for them in her local area was over two years.
She turned to the National Migraine Centre, which offers treatment at reduced cost, making it more accessible than fully private clinic care – and was prescribed Aquipta.
Her mother helped pay for the first course of treatment.
‘It was an absolute lifesaver,’ says Sylvia. ‘They cut my migraines in half, I’ve not vomited for four years – the treatment absolutely transformed my life.’
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