- A preventive drug for migraine proves effective at avoiding ‘rebound’ headaches in a new study.
- The medication is sufficiently effective that people taking it have less need for additional pain meds that can cause rebound headaches.
- The drug, atogepant, relaxes the blood vessel at which a migraine attack begins, preventing it from becoming too large and irritating the meninges at the bottom of the skull, causing the throbbing pain associated with migraine.
A drug used in the prevention of migraine may also help reduce so-called rebound headaches, according to a new review of data from a randomized, double-blind, placebo-controlled migraine trial.
When the drug, atogepant, is taken every day, migraine-related pain can be alleviated, decreasing the need for additional painkillers, believed to be the source of rebound headaches.
The study was led by headache specialist Peter J. Goadsby, MBBS, MD, PhD of King’s College London in the United Kingdom, and a member of the American Academy of Neurology.
Its findings appear in the journal Neurology.
There were 755 participants in the trial, each of whom experienced chronic migraine. Each had at least 15 days of headaches per month, with at least eight qualifying as migraine.
Out of the total group, 66% were overusing pain medications, which often occurs with people attempting to get rid of their headaches.
They were resorting to simple analgesics — such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or acetaminophen — for at least 15 days each month. Some took triptans or ergot alkaloids for at least 10 days. Some took a combination of both for at least 10 days in a month.
The trial began with a 4-week screening/baseline period.
At the beginning of the trial, participants averaged 18 to 19 migraine days per month, and were taking medications for pain for 15 to 16 days.
Next, individuals were randomly assigned to take 30 milligrams (mg) of atogepant twice daily, 60 mg of atogepant once each day, or a placebo for 12 weeks. During this period, they were monitored for the frequency of their painkiller use.
Participants who took atogepant took painkillers on fewer days during the trial. Additionally, a higher proportion of participants taking atogepant had a 50% or greater reduction in rebound headaches per month.
In general, said Goadsby, “[m]igraine is an inherited brain disease whose attacks are triggered by changes in the brain and changes in the external environment.”
“We know the path of physiology, but we don’t know what causes a migraine because there’s different triggers for different people,” Clifford Segil, DO, a neurologist at Providence Saint John’s Health Center in Santa Monica, CA, who was not involved in the study, told Medical News Today.
“For example,” he said, “many people with red wines versus white wines get it. Many people with cheeses get it. Caffeine both triggers headaches and treats headaches. So we’re still not entirely sure what causes the headaches.”
Modern, pharmaceutical therapies for migraine attacks fall into two camps: preventive and rescue. Atogepant is strictly a preventive drug, though it is closely related to two other drugs — ubrogepant and rimegepant — that are rescue and combination preventive/rescue drugs, respectively.
“Atogepant is a migraine preventive,” said Goadsby. “By taking it every day, the patient has less migraine and a much reduced need for acute treatments such as painkillers. In effect, it stops the attack before it starts.”
The drug “relaxes the [involved] blood vessel, which makes it get narrower and not as wide, and when it’s not as wide, it feels better,” Segil explained.
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