“There is a high prevalence of pain medication overuse among people with migraine as they try to manage what are often debilitating symptoms, however, medication overuse can lead to more headache called rebound headache; this problem is ideally treated by prevention."
Professor Peter Goadsby, Professor of Neurology at King’s IoPPN and the study’s lead author
28 June 2024
Migraine drug helps to prevent medication overuse
New research finds the headache drug, atogepant, is an effective means of decreasing migraine days in adults with chronic migraine.
The research, published in Neurology, suggests that atogepant can be used as a preventive measure in people overusing acute migraine medications like triptans, ergots and simple analgesics.
It’s estimated that between 1.4 per cent - 2.2 per cent of the global population experience chronic migraine, a debilitating neurological disease which sees people with migraine have at least fifteen days a month of headache regularly. People with chronic migraine often report significant headache-related disability and a low quality of life.
Medication overuse is associated with a higher intensity of headache/migraine pain, and worse pain relief outcomes over a 24 hour period. It can often result in “rebound headache” once the medication wears off. Researchers in this study wanted to assess how effective atogepant could be at preventing chronic migraine both in people who overuse acute medication, as well as those who don’t.
755 adults aged 18+ were recruited from 142 sites globally, with 500 (66.2 per cent) meeting the criteria for acute medicine overuse. All participants were then randomised into one of three groups – one group being asked to take 30mg of atogepant twice daily, one group taking 60mg of atogepant once daily, and a placebo control group. Participants were then asked to self-report the regularity of their migraine over three months, while still using their current medications.
At the end of the trial period, researchers found that, of the participants who overuse acute medication, 44.7per cent of those in the 30mg group, and 41.8 per cent of those in the 60mg group saw a more than 50per cent reduction in the number of days that they experienced migraines in a given month, compared to 24.9per cent of those people who received the placebo.
Of those participants who didn’t overuse their medication, 39.1 percent of the 30mg group, and 39.5 per cent of the 60mg group achieved a more than 50 percent reduction, compared to 28.6 per cent in the placebo arm.
Professor Peter Goadsby, Professor of Neurology at King’s IoPPN and the study’s lead author said,
“Based on our findings, treatment with atogepant could potentially decrease the risk of developing rebound headache by reducing the use of pain medications, and could lead to an improved quality of life for those living with migraine.”
The researchers intend to conduct further investigations assessing the long-term effectiveness and safety of atogepant. In the UK, NICE recently recommended it for the prevention of chronic and episodic migraine.
This study was possible thanks to funding from AbbVie.
Efficacy of Atogepant in Chronic Migraine With and Without Acute Medication Overuse in the Randomized, Double-Blind, Phase 3 PROGRESS Trial (DOI10.1212/WNL.0000000000209584) (Goadsby et al.) was published in Neurology.
Further reading - Migraine sufferers in England may soon be able to access preventative drug – here’s how atogepant works (The Conversation)
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Director of NIHR Clinical Research Facility & Professor of Neurology