• Posted June 27, 2024

Migraine Prevention Med Might Stop 'Rebound' Headaches, Too

It's a nasty cycle: Chronic migraine sufferers who use too much pain medication sometimes get smacked with rebound headaches.

But new research suggests that a medication commonly used to prevent migraines may also help fend off rebound headaches. 

The study of 755 people with chronic migraine -- meaning 15 or more headache days a month with migraines on eight or more -- found that those who overused pain meds had fewer headache days when taking the migraine prevention drug atogepant (Quilipta).

"There is a high prevalence of pain medication overuse among people with migraine as they try to manage what are often debilitating symptoms," explained study author Dr. Peter Goadsby, from King's College London. "However, medication overuse can lead to more headaches called rebound headaches, so more preventive treatments treatments are needed."

Two-thirds of the participants, who reported their headache and medication history, met the criteria for medication overuse.

That means they took pain relievers such as aspirin, acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) on 15 or more days a month; migraine drugs called triptans or ergots for 10 days or more; or any combination for 10 days or more.

On average, participants reported 18 to 19 migraine days a month and using pain meds on 15 to 16 days.

For 12 weeks, they were given 30 milligrams (mg) of atogepant twice daily; 60 mg once a day; or a placebo. Atogepant is a calcitonin gene-related peptide receptor antagonist, or CGRP inhibitor. CGRP is a protein that helps trigger migraines.

Participants with medication overuse who took atogepant twice a day averaged three fewer migraine days a month and three fewer headache days, compared to participants who took a placebo.

Those taking atogepant once a day had two fewer migraine days a month and two fewer headache days compared to the placebo group.

Researchers said similar results were seen in participants who were not overusing medications.

Among participants with overuse, 45% of those taking atogepant twice a day and 42% who took it once a day had at least a 50% reduction in average monthly migraine days compared to 25% among those taking the placebo, the study found.

Researchers said the number of participants who met the criteria for overuse dropped by 62% in the group taking the drug twice a day. It dropped 52% in once-a-day users.

"Based on our findings, treatment with atogepant may potentially decrease the risk of developing rebound headache by reducing the use of pain medications," Goadsby said in a journal news release. "This could lead to an improved quality of life for those living with migraine."

More research is needed to evaluate the drug's long-term effectiveness and safety.

Researchers noted that one limitation of the study is that participants self-reported their headaches and medication use, raising the possibility that some may have not done so accurately.

The study was funded by AbbVie, maker of atogepant.

The findings were published June 26 in the journal Neurology.

More information

Learn more about migraine headaches at the Cleveland Clinic.

SOURCE: Neurology, news release, June 26, 2024