WHO's essential medicines list: Additions for migraine and cluster headache

WHO’s essential medicines list (EML) is “the world’s most influential list of medicines”; more than 150 countries (threequarters of the world’s total) base their own lists upon it (1).Historically, people affected by primary headache disorder shave been poorly served by the EML. Until this year, only migraine was featured. Acute treatments were limited toacetyl salicylic acid, paracetamol (acetaminophen) and sumatriptan, with ibuprofen listed only for children. Propranolol was the sole preventative drug. The EML is reviewed biennially, and, since 2007, additions to it have been an unfulfilled ambition of the Global Campaign against Headache. Opportunity arose when, in2023, WHO invited Lifting The Burden (LTB) to submit proposals for the 2025 review. LTB asked the International Headache Society to lead the initiative and include the European Headache Federation in a joint working group(the authors). Three meetings were held to decide which drugs were to be proposed for which disorders. Tasks, which included detailed reviews of the evidence supporting each proposal, and cost-effectiveness analyses, were dele-gated to individual members. Nine proposals were submitted(Table 1), accompanied by letters of support from more than20 patient or scientific organisations (supplemental material).The overall workload was substantial (2).