Posts

What’s the Cost of a Blockbuster Headache Drug?

Migraine headaches remain the most common neurological disorder in the world. While there are a number of drugs that can target a stop a migraine attack in its tracks, there are many patients who have been resistant to current medications and have to endure several migraine days or more each month.

In the last 2 years, a new drug has hit the market that is targeting a promising chemical pathway that is known to affect migraine patients. The drug is called Aimovig. It is an inject-able antibody that hits a compound called calcitonin gene-related peptide or CGRP. It’s the first drug of it’s kind targeting this pathway as migraine medications have historically targeted blood vessels as a source of migraine related pain.

Image result for cgrp and migraine
Image Source: Russo AF.
Calcitonin gene-related peptide (CGRP): a new target for migraine.
Annu Rev Pharmacol Toxicol. 2015
Link:
https://www.ncbi.nlm.nih.gov/pubmed/25340934

Scientists and clinicians have been excited about this drug for a little while as clinical trials have shown it to be well-tolerated with few side-effects. It’s also promising in the fact that it seems to help reduce migraine frequency so it might serve a preventative purpose.

Cost Benefit Analysis

In terms of results, clinical trials on patients suffering from 8 headache days per month had a reduction of 3.7 headache days per month compared to 1.8 days on placebo. It also showed that 50% of the patients taking the drug were able to cut their headache days in half compared to 26% on placebo. [Source]

The price for Aimovig comes out to $575/month with an annual bill of $6900 which you may need to take throughout your life.

It might seem like a lot, but for many patients with treatment resistant migraines, the cost is worth it to experience less days wasted by the suffering of a migraine.

The Value of Upper Cervical Care

We know that a subset of migraine patients do extremely well with upper cervical chiropractic care. If you talk to many doctors, they will often report that many of their patients will have greater than 50% reduction in their headache days, with some having an almost complete resolution.

This is because a large number of patients who have several migraines per month also have an upper cervical spine problems which are a known driver of migraines. A small study looking at the effects of NUCCA on migraine cases showed a significant reduction in migraine days and large improvements in migraine disability.

You can read the full paper here: Effect of Atlas Vertebrae Realignment in Subjects with Migraine: An Observational Pilot Study

Migraine patients under NUCCA care with headache days and quality of life improvements at 4 weeks and 8 weeks.
Migraine disability scores significantly improved in NUCCA patients from baseline to 12 weeks

This was a small study with no control group, so we can’t tell exactly how effective this is on a large scale. However, the experience seen by the patients in this study is a close reflection to what we see in clinical practice everyday.

Probably the most significant aspect of upper cervical care is the fact that it’s capable of producing these outcomes at significantly less expense. For many chronic migraine patients, getting them to the point where a reduction in their migraine days are stable can happen within 8-12 weeks.

Once they’re there, then patients are usually ready for periodic visits to maintain their atlas alignment. While costs vary, the average migraine patient in our clinic might spend $1500-1800 in their first year with us, and a few hundred dollars in subsequent years.

A large difference from $6900 a year on going.