The best medications we currently have to treat migraine attacks are the triptans. In Aotearoa New Zealand, we have two of these: sumatriptan and rizatriptan. But although these can be very effective if taken early in an attack, they don’t work for everyone. And some people can’t take them because they constrict blood vessels, which is not a good idea when you have heart disease or another condition that reduces the blood supply to critical organs.
In 2019, the United States Food and Drug Administration approved lasmiditan for acute treatment of migraine. This was a ‘ditan’, related to the triptans, and the first of its kind. The only one, as it has turned out. The advantage it had over the triptans, and the reason it was developed, was because it didn’t cause blood vessel constriction so it was able to be used by people who couldn’t take triptans because of vascular contraindications. It also could work for some people when triptans had failed.
We have never had lasmiditan here in Aotearoa and we never will, because as of November 2025, it has been discontinued. The manufacturer has stopped making it. Apparently, it wasn’t profitable enough. Even though the real-world experience from patients who used it was positive – it was a treatment lifeline for those who couldn’t take or tolerate other options. It had side effects, most commonly dizziness and sedation, which meant you couldn’t drive for 8 hours after use. But it was otherwise found to be safe and people kept using it, despite this downside, because an untreated migraine attack is far worse than not being able to drive a car.
The loss of lasmiditan, for those of us in NZ who never had the chance to try it, represents a loss of possibility. And a deeper concern, that useful migraine medications can be taken off the market because profits are more important than patients. What can we do about it? We can keep raising the profile of migraine disease and its impact and the huge unmet need for new and better treatments. There is still so much we do not know about migraine and how to manage it. We want more research and innovation. Ultimately, we’d like a world where we fully understand the migraine brain and have tailored solutions for everyone that prevent migraine attacks from happening. Until then, a full range of treatment options is what we aspire to.
