Atogepant reduces incidence of rebound headaches by 50%

The trial involved 755 participants, all with chronic migraines. Each of them had headaches on at least 15 days a month, with at least eight of those days being migraines.

Of the group as a whole, 66% misused painkillers, which often happens to people trying to get rid of their headaches.

They took simple painkillers, such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or paracetamol, for at least 15 days a month. Some took triptans or ergot alkaloids for at least 10 days. Some took a combination of the two for at least 10 days a month.

The trial began with a 4-week screening/baseline period.

At the start of the trial, participants had an average of 18 to 19 migraine days per month and took pain medication for 15 to 16 days.

Then, the subjects were randomly assigned to take 30 milligrams (mg) of atogepant twice a day, 60 mg of atogepant once a day, or a placebo for 12 weeks. During this period, the frequency of their painkiller use was monitored.

Participants taking atogepant took painkillers on fewer days during the trial. Additionally, a higher proportion of participants taking atogepant experienced a 50% or greater reduction in rebound headaches per month.

In general, Goadsby said, “migraine is an inherited brain disease in which attacks are triggered by changes in the brain and changes in the external environment.”

“We know the physiology, but we don’t know what triggers a migraine because there are different triggers for different people,” said Clifford Segil, DO, a neurologist at Providence Saint John’s Health Center in Santa Monica, Calif., who was not involved in the study. Today’s Medical News.

“For example,” he says, “a lot of people who drink red wine instead of white wine get it. A lot of people who drink cheese get it. Caffeine triggers and treats headaches. So we don’t know exactly what causes headaches yet.”

Modern pharmaceutical treatments for migraine attacks fall into two categories: preventative and rescue. Atogepant is a strictly preventative medication, although it is closely related to two other medications—ubrogepant and rimegepant—which are reliever and combined preventative/rescue medications, respectively.

“Atogepant is a migraine preventative medication,” Goadsby said. “By taking it every day, the patient has fewer migraines and has much less need for emergency treatments like painkillers. In fact, it stops the attack before it starts.”

The drug “relaxes the (involved) blood vessel, which causes it to become narrower and less wide, and when it’s not as wide, you feel better,” Segil explained.

Goadsby also explained rebound headaches and why they occur. He told us that:

“A rebound headache occurs when a medication taken to relieve an attack wears off and the headache returns. Let’s say you have a migraine that lasts 2 days. If you take a medication on the first day that lasts 24 hours, the headache will return (rebound) the next day and you will need to take another medication.”

“The major problem with migraines is that people take too much medication, which can cause what’s called a ‘medication overuse headache’ or a ‘rebound headache.’ The simplest example is someone who has pain and takes an NSAID Motrin, Advil or Alleve (or another one) every day,” Segil says.

Goadsby also warned that some painkillers, such as NSAIDs, taken too often can lead to stomach ulcers and other digestive tract problems.

“Taking painkillers can, paradoxically, increase the number of migraine days where the patient suffers from what is called medication overuse headache. Therefore, taking fewer painkillers helps prevent this from happening,” he said.

According to Segil, overuse of painkillers may never allow a migraine attack to go away.

A migraine is a severe headache that is classically characterized by a throbbing pain, sometimes covering half of the head.

It may be accompanied by an uncomfortable sensitivity to bright lights and loud noises – photophobia or phonophobia, respectively – with or without blurred vision or visual aura, a difficult-to-describe symptom in which vision becomes prismatic.

“Typically when people have migraines, there’s a blood vessel between the brain and the skull in the meninges, and when the blood vessel gets too big, it dilates. It pulls on the meninges (which are) the shock absorbers of the brain. That’s what usually causes the throbbing pain,” Segil says.

“After that, there is irritation of the cerebral cortex and a wave of electricity called propagating cortical depression, and that’s usually the radiating pain,” he detailed.