A recent study published in the June 26, 2024, online edition of Neurology®, the medical journal of the American Academy of Neurology, suggests that a medication used for preventing migraines could also be beneficial for individuals experiencing rebound headaches.
Individuals with chronic migraines who overuse pain medication may have fewer monthly migraine and headache days and use less pain medication if they take the migraine prevention drug atogepant.
Lead study author Peter J. Goadsby, MD, PhD, from King’s College London and a member of the American Academy of Neurology, highlighted the prevalence of pain medication overuse in individuals with migraines as they attempt to manage severe symptoms. However, excessive medication use can lead to rebound headaches, underscoring the need for more effective preventive solutions. The study results indicate that atogepant could potentially reduce the dependency on pain medication among those with chronic migraines.
The study involved 755 participants diagnosed with chronic migraines, which are characterized by having 15 or more headache days per month, with at least eight classified as migraines.
Of the participants, 66% met the criteria for medication overuse, defined as using pain medications like aspirin, NSAIDs, or acetaminophen for 15 or more days per month, triptans or ergots for 10 or more days per month, or a combination for 10 or more days.
At the study’s outset, participants averaged 18 to 19 migraine days and 15 to 16 pain medication days per month.
During the 12-week study period, participants received either 30 mg of atogepant twice daily, 60 mg once daily, or a placebo. Atogepant is a CGRP inhibitor, targeting a protein pivotal in initiating migraines.
Participants documented their migraines and headaches in an electronic diary, recording details like duration, intensity, presence of aura or nausea, and use of other medications.
The results showed that participants with medication overuse experienced an average of three fewer migraine days and three fewer headache days per month when taking atogepant twice daily compared to the placebo group. Taking the drug once a day led to two fewer migraine days and two fewer headache days. Additionally, both groups reported three fewer days of using pain medication compared to the placebo group. Similar reductions were observed for participants without medication overuse.
Among those with medication overuse, 45% of those taking atogepant twice daily and 42% taking it once a day had a 50% or higher reduction in average monthly migraine days, compared to 25% in the placebo group.
Furthermore, the number of individuals meeting the criteria for medication overuse decreased by 62% for those taking atogepant twice daily and 52% for those taking it once a day.
Goadsby commented that treatment with atogepant could potentially lower the risk of developing rebound headaches by reducing pain medication use, ultimately enhancing the quality of life for migraine sufferers.
He also emphasized the necessity for further studies to assess the long-term safety and effectiveness of atogepant, as well as the potential for medication overuse relapse in individuals with migraines.
One study limitation was the reliance on participants to accurately record their headaches and medication use in electronic diaries, which may lead to some inaccuracies.
The study was sponsored by AbbVie, the manufacturer of atogepant. Goadsby disclosed receiving personal fees from AbbVie during the study.
