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Medical News Today Quotes Dr. Williams: New drug may help prevent episodic migraine in difficult cases

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  • Migraine affects more than 1 billion people globally every year.
  • There is currently no cure for migraine headaches, which can have a major impact on a person’s quality of life.
  • Researchers from Vall d’Hebron University Hospital in Spain recently presented research showing the drug atogepant helps prevent headaches in people with episodic migraine who have had no success with other preventive drugs.
  • Scientists also reported the drug helps reduce how many migraine days a person has per month and reduces the amount of medication they need to take.

More than 1 billion people around the world are affected by migraine every year.

There is currently no cure for this type of severe headache, which can have a profound effect on a person’s quality of life.

Although there are medications that can help with migraine, they do not always work for every person.

Now, researchers from Vall d’Hebron University Hospital in Barcelona, Spain, have presented research at the American Academy of Neurology’s 75th annual meeting showing the drug atogepant — already approved in the United States as a preventative treatment for episodic migraine— helps prevent episodic migraine headaches for people who have had no success with other preventive drugs.

Additionally, scientists say the drug helps reduce how many migraine headaches per month study participants had and how often they need to take medication to stop a migraine attack.

What is episodic migraine?

Migraine is a neurological condition causing recurring headaches — usually on one side of the head — with an intense throbbing or pulsing sensation.

Other symptoms of migraine include:

If a person experiences up to 14 migraine headaches in a month, they have what’s known as episodic migraine. If they have 15 or more headaches each month, that is known as chronic migraine.

Migraine headaches can be caused by a variety of triggers, including:

Headaches impact life quality

Dr. Vernon Williams, a sports neurologist, pain management specialist, and founding director of the Center for Sports Neurology and Pain Medicine at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles, told Medical News Today is it not uncommon to see people with episodic migraine who have had no success with preventative drugs.

“Some patients respond well to a number of different preventive medications. Others will have side effects or difficulty with just poor efficacy from preventive medications,” he explained.

Williams said it is important to have preventative medications for episodic migraine headaches as they can significantly affect a person’s ability to function and diminish their quality of life.

“If the migraines are negatively impacting someone’s function, quality of life, their ability to do the things they’d like to do, want to do, and need to do, it’s very helpful to have an agent like this that can prevent them and reduce the frequency of the headaches,” he said. “So, maybe instead of getting four or five headaches a month, eight or 10 headaches a month, they are getting one headache a month or one headache every other month.”

“You can see how that would have an effect on people’s performance at work, their abilities to do the things they need to do at school, care for their family, (and) interact with loved ones,” Williams added. “It’s all about improving people’s ability to do the things they’d like to do, need to do, want to do without the difficulties associated with these episodic migraine attacks that can prevent them from being able to be fully present in their lives.”

CGRP inhibitors and episodic migraine

According to Dr. Medhat Mikhael, a pain management specialist and medical director of the non-operative program at the Spine Health Center at MemorialCare Orange Coast Medical Center in California, doctors currently treat migraine headaches with a variety of medications, including beta-blockers, calcium channel blockers, and anti-seizure medications.

However, he said, they were not always effective.

Mikhael told Medical News Today that with the class of calcitonin gene-related peptide (CGRP) inhibitors — including atogepant — now available for migraine treatment and prevention, they are seeing better results.

“We saw… not only less migraine days, (but also) a lot less severe (migraine headaches that) can be treated with some over-the-counter (medications),” he continued. “And in some patients, they have gone without any migraine or monthly migraine headache days at all.”

Mikhael explained what makes CGRP inhibitors effective at both preventing and stopping migraine headaches is that by binding the receptor of the CGRP, you prevent a cascade of reactions that cause the trigeminal nerve in the head to become inflamed and dilated.

“What is good about (CGRP inhibitors) is it does not cause any vasoconstriction of the trigeminal arterylike the class of the triptans that we use a lot to avoid migraine,” he added. “So, with CGRP inhibitors, you don’t see any patients have chest tightness, chest pain, neck tightness, (or) flushing in the face. (The) side effect profile (is) very low and very well tolerated by most of the patients as far as that class of drugs.”

Evaluating CGRP Inhibitors

In the new study, researchers evaluated the efficacy, safety, and tolerability of atogepant — a type of CGRP inhibitor — for the prevention of episodic migraine in people who had previously failed two to four types of oral preventative medications.

The 309 participants in the study either received atogepant or a placebo for 12 weeks.

Upon analysis, the research team reported that participants who took atogepant had an average of four fewer days of migraine per month from the start of the study to its conclusion, compared to only two fewer days in those who took the placebo.

Additionally, scientists found those who took the drug showed improvement in how often they needed to take medications to stop a migraine attack, compared to those who took the placebo.

Researchers reported the most common side effects were constipation and nausea.

“People who thought they may not find a way to prevent and treat their migraines may have hope of finding relief with a tolerable oral easy-to-use drug,” said Dr. Patricia Pozo-Rosich, a study author and director of the Headache and Neurological Pain Research Group at Vall d’Hebron University Hospital. “This treatment was safe, well-tolerated, and effective for people with difficult-to-treat migraine.”

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