Migraine Drug May Also Prevent Rebound Headaches

On Thursday, June 27, 2024, new research unveiled a potential breakthrough for individuals suffering from chronic migraines, specifically those who experience rebound headaches due to excessive pain medication usage. This study investigated the efficacy of the migraine prevention drug atogepant (Quilipta) in reducing headache frequency among chronic migraine sufferers who overuse pain medications.

The research involved 755 participants who suffered from chronic migraines, defined as experiencing 15 or more headache days per month, with migraines occurring on at least eight of those days. These individuals often resort to overusing pain relief medications, which can lead to rebound headaches. The study aimed to determine if atogepant could mitigate this issue.

Dr. Peter Goadsby of King's College London, the study's lead author, emphasized the cycle of pain medication overuse among migraine sufferers. He noted that while these individuals often turn to pain relievers to manage severe symptoms, the overuse can trigger more headaches, known as rebound headaches. This highlights the need for effective preventive treatments.

The participants provided detailed accounts of their headache and medication histories. Two-thirds of them met the criteria for medication overuse: taking pain relievers like aspirin, acetaminophen, or NSAIDs for 15 or more days a month; using migraine-specific drugs such as triptans or ergots for 10 days or more; or combining these medications for 10 or more days.

During the 12-week study, participants were divided into groups receiving either 30 milligrams (mg) of atogepant twice daily, 60 mg once daily, or a placebo. Atogepant functions as a calcitonin gene-related peptide receptor antagonist, or CGRP inhibitor, targeting the protein that triggers migraines.

The outcomes were promising. Participants who overused pain medications and took atogepant twice daily experienced an average reduction of three migraine days and three headache days per month compared to those on the placebo. Those who took the drug once daily had two fewer migraine days and two fewer headache days per month than the placebo group. Similar results were observed among participants who did not overuse medications.

Significantly, 45% of participants who took atogepant twice daily and 42% who took it once daily saw at least a 50% reduction in their average monthly migraine days, compared to just 25% in the placebo group. Moreover, the number of participants meeting the criteria for medication overuse dropped by 62% in the twice-daily atogepant group and by 52% in the once-daily group.

Dr. Goadsby highlighted that these findings suggest atogepant could reduce the risk of rebound headaches by decreasing reliance on pain medications, potentially improving the quality of life for those with chronic migraines. However, he cautioned that more research is necessary to assess the drug's long-term efficacy and safety.

One limitation of the study is the reliance on self-reported data from participants, which could introduce inaccuracies. The study received funding from AbbVie, the manufacturer of atogepant, and the findings were published in the June 26 edition of the journal Neurology.