Summary: Migraine headaches are quite challenging to treat, and not all patients respond well to medical treatment. Some patients continue to experience headaches most days every month. In such patients, drug overuse is pretty common, which often leads to rebound headaches. A new study shows that Atogepant, a drug approved for preventing migraine headaches, may also help prevent rebound headaches and drug overuse and thus enhance the quality of life of patients.
Migraine is not a rare problem, and in some, it tends to be pretty severe. Although there are many drugs to treat migraine, but none is effective in all the cases. For many, migraine headaches remain a constant problem despite using multiple medications.
Nonetheless, though slowly, progress is being made in understanding migraine headaches, one of the leading causes of severe chronic pain syndromes.
However, there are other issues with those who have chronic migraine that would not respond well to medical treatment. This problem is of drug overuse. Since nothing seems to help well in many patients, they are more likely to overuse medications like aspirin, acetaminophen, and other painkillers.
However, the issue with the overuse of painkillers is that many of them start suffering from so-called rebound headaches, known medically as medication overuse headache. Such kinds of headaches are even more difficult to treat.
In this new study, researchers tested one of the new drugs in patients who would experience 15 or more days of headaches a month and eight or more days of migraine headaches a month. So, they were pretty serious patients not responding well to commonly used painkillers.
In this study, researchers tested a new drug belonging to the class of drugs called calcitonin gene-related peptide (CGRP) receptor antagonists. The drug is named Atogepant, and it is already approved for preventing migraine headaches. However, in this new study, researchers were interested not only in reducing migraine attacks in treatment-resistant patients but also in reducing episodes of rebound headaches that mainly occur due to the overuse of painkillers.
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Two-thirds of the patients in this study (500 of 755) met the criteria for acute medication overuse: simple painkillers on 15 or more days a month, or triptans, ergots, or combinations of these medications on 10 or more days a month.
In the study, patients were randomly assigned to one of three groups for 12 weeks: atogepant 30 mg twice daily, atogepant 60 mg once daily, or placebo.
In the study, researchers found that atogepant reduced migraine and headache days and, as a result, reduced the use of painkillers in this category of patients.
Before treatment, these patients had about 19 migraine days a month. Among patients with medication overuse, compared with placebo, those taking atogepant 30 mg twice daily reported on average 2.7 fewer migraine days a month, and those taking 60 mg once daily reported 1.9 fewer.
Of course, the results are far from ideal, and these patients still continue to experience migraine headaches. However, it was encouraging to see that this drug worked in those relatively resistant to other painkillers. This medication significantly helped reduce the overuse of other painkillers. Compared with placebo, patients on atogepant used acute medications on about 2.6 to 2.8 fewer days a month, and the share of atogepant-treated patients who still met the criteria for medication overuse fell by 52% to 62% over 12 weeks, which is significant.
So, researchers say that this new medication can not just help overcome headaches but may significantly help reduce the use of painkillers. This may significantly enhance the quality of life of patients.
When managing chronic pain syndrome like migraine headaches, reducing pain severity or pain episodes is not the only aim of the treatment. It is also vital to reduce the use of medications, focusing on improving patients’ quality of life. Consulting with a chronic pain specialist in St. Louis can help you achieve that dream.
Source:
Goadsby, P. J., Friedman, D. I., Holle-Lee, D., Demarquay, G., Ashina, S., Sakai, F., Neel, B., Gandhi, P., Dabruzzo, B., Smith, J. H., Liu, Y., & Trugman, J. M. (2024). Efficacy of Atogepant in Chronic Migraine With and Without Acute Medication Overuse in the Randomized, Double-Blind, Phase 3 PROGRESS Trial. Neurology, 103(2), e209584. https://doi.org/10.1212/WNL.0000000000209584
Dr. Gurpreet Singh Padda, MD, MBA, MHP
