Blog #9: Migraine medications for New Zealand adults
There’s no denying New Zealand needs to increase funding and improve access to more medications to manage migraine. But medication funding in New Zealand is complex, and Pharmac often gets a bad a rap about what medications it does and doesn’t fund.
However, there’s also a wider issue of how Pharmac is funded that impacts on what it can fund, and medication such as Botox are approved for funding by Pharmac, but individual district health boards decide if they’ll fund it – and most don’t.
If you think you’ve tried every medication to tame your migraine beast, possibly you have. But there are lots of different medications available and sometimes it’s about you and your doctor finding a combination that works.
That’s why I’ve put together a list of what’s available in NZ, including if you need a prescription and whether it’s funded.
But before I jump into your medication options, let’s pause for a moment to appreciate how far we’ve come in managing migraine disease and be thankful we live in the 21st century.
These 2 descriptions of migraine treatment I found while researching the history of migraine disease. There’s a bit of medical jargon but you don’t need to understand every word to appreciate modern medicine.
“Take the shaft of a thick goose feather, scrape off a bit from the outer layer and make notches into the fibres so that it results in teeth like on a saw. Subsequently, push the shaft inside the nose up to the ethmoid bones, move it with both hands in order to create scratches at that site. In this way, a lot of blood will be discharged in a short time, as many small veins end there, and the site is soft and easy to injure.”
And also:
“Some physicians incise down to the bone on the forehead along the border of the hair. They abrade or chisel the bone down to the diploe and let flesh grow over the place. Others perforate the bone down to the meninges. These are hazardous treatments.” (1)
And my mum, also a migraine club member, recently reminded me my great-grandmother had all her teeth removed because it was recommended as a way to help with migraine. So even though 2020 seems a bit of a write-off in parts thanks to COVID-19, I’m glad I’m managing my migraine disease now, and not way back when.
Many migraine medications are available on prescription only, but you can also get a prescription for over-the-counter medications such as ibuprofen and naproxen that makes them cheaper – you’ll only pay the prescription surcharge. And some health insurance policies cover the prescription surcharge, so you don’t pay anything.
A huge thank you to Auckland neurologist, Dr Rosamund Hill, for reviewing this medication list.
Medications used in New Zealand to manage migraine disease
Pain relief medications
Funded and available without a prescription
Paracetamol
Paracetamol plus caffeine
Soluble aspirin
Short acting non-steroidal anti-inflammatory medications
Funded and available without a prescription
Ibuprofen
Diclofenac
Naproxen (higher dose needs a prescription)
Medications that help with migraine-related nausea and vomiting
Funded, prescription only medicine
Metoclopramide
Ondansetron
Medications that help during a migraine attack (abortive)
Triptans are the only funded medications in New Zealand specifically developed for migraine disease.
Funded, prescription only medicine
Sumatriptan, though you can buy sumatriptan 50mg without a prescription
Rizatriptan
Medications to prevent migraine (preventative)
These medications were developed to manage other conditions such as high blood pressure and depression but were found to be effective for migraine prevention.
Funded, prescription only medicine
Propranolol
Nadolol
Metoprolol
Amitriptyline
Nortriptyline
Topiramate
Sodium valproate
Pizotifen
Gabapentin
Pregabalin
Candesartan
Verapamil
Lamotrigine
Approved by Pharmac for preventative migraine treatment but mostly unfunded by district health boards
Botox (onabotulinum toxin A)
In-hospital infusions for migraine
Chlorpromazine infusion
Prochlorperazine infusion – intramuscular or intravenous
Dihydroergotamine (DHE) infusion
Medications for menstrual migraine
A combination of the above medications may be used for menstrual migraine, particularly naproxen. Oral contraception to prevent ovulation and oestrogen, such as estradiol may also be used. All are funded and prescription only medicine.
And then there are the calcitonin gene-related peptide monoclonal antibody medications
Calcitonin gene-related peptide (CGRP) monoclonal antibodies are the first medications developed specifically to prevent migraine. These medications are really exciting as most medications used for migraine disease (besides triptans) were developed to manage other health issues.
CGRP is a protein involved in the cascade of events that lead to a migraine attack. (2). When it’s released it binds to CGRP receptors and causes pain.
CGRP monoclonal antibodies stop the action of CGRP by either binding to CGRP itself or binding to the receptor sites found in some parts of the nervous system such as the trigeminal nerve.
The Food and Drug Administration (FDA) has approved 4 CGRP medications. Erenumab (Aimovig), Fremanezumab (Ajovy) and Galcanezumab (Emgality) are once a month self-injection, while Eptinezumab (Vyepti) is a one-hour intravenous infusion every 3 months.
Medsafe has approved Aimovig 70mg and 140mg in New Zealand and Kiwis first had access to it from earlier this year. It’s available on prescription, but it’s not funded, and a 70mg injection costs $678.
Following the 64th Medicines Classification Committee meeting in July, Medsafe recommended Emgality (Galcanezumab) should be classified as a prescription medication in New Zealand. Hopefully we’ll have access later in the year. Again, it won’t be funded.
Managing migraine disease is complex, time-consuming and damn hard. But, it’s worth trying different medications, and different combinations of medications, to help improve your quality of life.
And when you’re having a rough day with your migraine beast, remember: no-one, thankfully, will be pushing a saw-like goose feather up your nose like our ancestors were subjected to.
In a future blog post I’ll focus on what medications we don’t have access to in New Zealand. Did you know there are 7 triptans approved for migraine disease! And there are also oral CGRP antagonists…
Until then, wishing you many migraine free days.
Check out Health Navigator for some great migraine resources, including further migraine medication information.
And a disclaimer: The list is an overview of what medications are used to manage migraine disease in New Zealand to help better inform Kiwis. It doesn’t include dosages or other information such as side effects which are important for you to talk about with your doctor.
References
A history of non-drug treatment in headache, particularly migraine, Brain, Volume 133, Issue 8, August 2010.
Calcitonin Gene-Related Peptide Antibodies (CGRP) for Migraine, Migraine and Headache Australia, January 2019
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