Summary: A new study shows that Atogepant, a drug approved for preventing migraine headaches, may also help prevent rebound headaches and drug overuse. That may improve patients’ quality of life. Migraine headaches are hard to treat, and not every patient responds to drugs. Some still have headaches most days of every month. These patients often overuse their drugs. That overuse often leads to rebound headaches.
Migraine is not rare, and for some people it is severe. There are many migraine drugs, but none works for everyone. For many people, migraine stays a constant problem despite several medications.
Still, slow progress is being made in understanding migraine headaches. Migraine is one of the leading causes of severe chronic pain.
People with chronic migraine that resists treatment face another problem: drug overuse. When nothing seems to help, they are more likely to overuse aspirin, acetaminophen, and other painkillers.
The trouble is that painkiller overuse brings on rebound headaches in many of them. The medical name is medication overuse headache. These headaches are even harder to treat.
In this new study, researchers tested one of the new drugs in patients who had 15 or more days of headaches a month and eight or more days of migraine headaches a month. These were serious cases. Common painkillers were not working for them.
The drug belongs to a class called calcitonin gene-related peptide (CGRP) receptor antagonists. It blocks the receptor for a protein that drives migraine pain. The drug is named Atogepant, and it is already approved for preventing migraine headaches. In this study, researchers wanted two things. They wanted fewer migraine attacks in hard-to-treat patients. They also wanted fewer rebound headaches, which come mainly from painkiller overuse.
Book Your Migraine Consultation Today!
Two-thirds of the patients in this study (500 of 755) met the criteria for acute medication overuse. That meant simple painkillers on 15 or more days a month. Or it meant triptans, ergots, or combinations of these drugs on 10 or more days a month.
Patients were randomly assigned to one of three groups for 12 weeks: atogepant 30 mg twice daily, atogepant 60 mg once daily, or placebo.
Atogepant cut migraine and headache days. As a result, these patients used fewer painkillers.
Before treatment, these patients had about 19 migraine days a month. Look at the patients with medication overuse. Compared with placebo, those on atogepant 30 mg twice daily had 2.7 fewer migraine days a month on average. Those on 60 mg once daily had 1.9 fewer.
The results are far from ideal. These patients still have migraine headaches. But the drug worked in people who did poorly on other painkillers. That is good news. It also significantly cut painkiller overuse. Compared with placebo, patients on atogepant used acute drugs on about 2.6 to 2.8 fewer days a month. The share of treated patients who still met the overuse criteria fell by 52% to 62% over 12 weeks. That is a significant drop.
So researchers say this drug does more than ease headaches. It may also significantly cut painkiller use. That may significantly improve patients’ quality of life.
With chronic pain like migraine headaches, less pain and fewer attacks are not the only goals. Using fewer drugs matters too, because the real target is a better life. Seeing a chronic pain specialist in St. Louis can help you achieve that dream.
Frequently asked questions
What is a rebound headache?
A rebound headache, known medically as medication overuse headache, comes from taking painkillers too often. People whose migraines resist treatment often reach for aspirin, acetaminophen and other painkillers most days of the month. That overuse sets off more headaches. Rebound headaches are even harder to treat than the migraines that started the cycle.
What are the criteria for medication overuse headache?
In the atogepant study, a patient counted as overusing if they took simple painkillers on 15 or more days a month. Taking triptans, ergots or combinations of these drugs on 10 or more days a month also counted. By that standard, two-thirds of the patients in the study (500 of 755) were already overusing their headache drugs.
Does atogepant help rebound headaches?
Yes, in this study. Atogepant is a CGRP receptor antagonist already approved to prevent migraine. It helped patients with chronic migraine who were overusing painkillers. It cut migraine and headache days. It also cut the days they needed acute drugs by about 2.6 to 2.8 a month compared with placebo. The share of treated patients who still met the overuse criteria fell by 52% to 62% over 12 weeks.
How many fewer migraine days did patients have on atogepant?
These patients started with about 19 migraine days a month. Among those overusing drugs, atogepant 30 mg twice daily brought 2.7 fewer migraine days a month than placebo on average. The 60 mg once-daily dose brought 1.9 fewer. The results are far from ideal, and patients still had migraines. But the drug worked in people who had not done well on other painkillers.
How do you get rid of a headache from medication overuse?
The goal is fewer headaches and fewer painkiller days, because the overuse itself drives the rebound. In this study, a preventive drug lowered both headache days and painkiller use. That can improve quality of life. A chronic pain specialist in St. Louis can build a plan that works on both at once.
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
