Quilipta May Prevent Rebound Headaches

THURSDAY, June 27, 2024 -- Chronic migraine sufferers often fall into a vicious cycle: using excessive pain medication, which can lead to rebound headaches. However, new research indicates that a medication typically used to prevent migraines, atogepant (Quilipta), might also help reduce these rebound headaches.

The study involved 755 individuals with chronic migraines, characterized by having headaches for 15 or more days each month, with migraines on at least eight of those days. Participants who overused pain relief medications experienced fewer headache days while taking atogepant. Dr. Peter Goadsby of King's College London, the study's lead author, emphasized the prevalence of pain medication overuse among migraine sufferers, who often try to alleviate their debilitating symptoms, only to face more headaches as a result. Hence, there is a need for more preventive treatments.

In the study, two-thirds of the participants met the criteria for medication overuse. This was defined as 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 or more days, or any combination of these for 10 days or more. On average, the participants reported experiencing migraines for 18 to 19 days each month and using pain medications for 15 to 16 days.

Over a 12-week period, participants were administered either 30 milligrams (mg) of atogepant twice daily, 60 mg once daily, or a placebo. Atogepant acts as a calcitonin gene-related peptide receptor antagonist (CGRP inhibitor), a protein known to trigger migraines. Participants who overused medication and took atogepant twice daily saw three fewer migraine and headache days per month compared to those who took the placebo. Those who took atogepant once daily experienced two fewer migraine and headache days per month relative to the placebo group.

Similar results were observed among participants who did not overuse medications. Among those who overused medications, 45% of participants taking atogepant twice daily and 42% taking it once daily experienced at least a 50% reduction in their average monthly migraine days. This was significantly higher compared to the 25% reduction seen in the placebo group. Furthermore, the number of participants meeting the overuse criteria dropped by 62% in the twice-daily atogepant group and by 52% in the once-daily group.

Dr. Goadsby noted that based on the study’s findings, atogepant could potentially decrease the risk of developing rebound headaches by reducing the use of pain medications, which would significantly enhance the quality of life for those suffering from migraines. However, further research is needed to evaluate the long-term effectiveness and safety of the drug.

One limitation of the study is the reliance on participants to self-report their headaches and medication usage, which raises the possibility of inaccurate reporting. The study was funded by AbbVie, the maker of atogepant, and the findings were published on June 26 in the journal Neurology.