'Migraine drug could help prevent the overuse of painkillers'

Dr Miriam Stoppard on the news that atogepant, a headache drug, may potentially decrease the risk of developing rebound headaches experienced by migraine sufferers, leading to an improved quality of life for patients

Around 1%-2% of people ­worldwide suffer migraines, with debilitating headaches experienced at least 15 days a month. People with chronic migraines often report they’re significantly ­disabled by them and they affect their quality of life.

As a past migraine sufferer I know too well the temptation, when in the throes of a crippling headache, to take too many painkillers. But overusing pain medication is linked to more severe headache/migraine pain, and worse pain relief.

It can often result in “a rebound ­headache” once the medication wears off. King’s College London researchers wanted to assess how effective ­atogepant, the headache drug, could be at preventing chronic migraines in people who overuse ­medication, as well as in those who don’t.

The good news is atogepant decreases migraine days in people who suffer chronically – and could be used to prevent people overusing migraine medications.

For the study, 755 adults aged over 18 were recruited from 142 centres around the world, with 500 (66%) ­overusing migraine medicines. All participants were then randomised into one of three groups – the first took 30mg of atogepant twice daily, the second 60mg of atogepant once daily, and a placebo control group.

Participants self-reported the frequency of their migraines over three months, while still using their current medications. The results are ­promising: 44.7% of those in the 30mg group, and 41.8% of those in the 60mg group saw a more than 50% reduction in the number of days they had migraines in a given month, compared to 24.9% of those people who received the placebo. Of those participants who didn’t overuse their medication, 39.1% of the 30mg group, and 39.5% of the 60mg group achieved a more than 50% reduction, compared to 28.6% in the placebo group.

“There is a high prevalence of pain medication overuse among people with migraines as they try to manage what are often debilitating symptoms.

“However, overuse of medication can lead to more headaches, and this problem is ideally treated by prevention,” said Professor Peter Goadsby, professor of neurology at King’s Institute of Psychiatry, Psychology and Neuroscience, and the study’s lead author.

He added: “Based on this, treatment with atogepant may potentially decrease the risk of developing rebound headache by reducing the use of pain medications, and could lead to an improved quality of life for patients.”

Researchers intend to conduct further investigations assessing the long-term effectiveness of atogepant. In the UK, NICE has recently ­recommended it for the prevention of chronic and episodic migraines.