A new study finds that a drug used to prevent migraines may also be effective in reducing rebound headaches caused by overuse of pain medication in people living with chronic migraine.
Medication Overuse Cut Significantly
The study, published on June 26 in Neurology, involved 755 participants with chronic migraine. Atogepant (Qulipta), a calcitonin gene-related peptide (CGRP) receptor antagonist, works by blocking a protein crucial in initiating the migraine process. It received U.S. approval in 2021.
Participants taking atogepant twice daily for 12 weeks reported an average of three fewer migraine and headache days per month than the placebo group. Those taking it once daily experienced two fewer migraine and headache days per month.
The study, funded by AbbVie, the drug’s manufacturer, also found a significant reduction in medication overuse. Among participants taking atogepant twice daily, acute pain medication overuse decreased by 62 percent, while those taking it once daily saw a 52 percent reduction.
These findings suggest atogepant may help reduce the risk of rebound headaches by decreasing acute pain medication use, potentially improving the quality of life for migraine sufferers.
“There is a high prevalence of pain medication overuse among people with migraine as they try to manage what are often debilitating symptoms,” study author Dr. Peter J. Goadsby of King’s College London, a member of the American Academy of Neurology, said in a statement. He described the findings as “encouraging,” indicating that atogepant may help reduce pain medication dependence in chronic migraine patients.
However, Dr. Goadsby, who reported receiving personal fees from AbbVie during the study, noted that further research is needed to evaluate atogepant’s long-term safety, effectiveness, and potential risk of medication overuse relapse.
Common side effects of atogepant include nausea, fatigue, constipation, decreased appetite, weight loss, and dizziness.
Migraine Drugs Are a Double-Edged Sword
Headache disorders, including migraines, tension-type headaches, and cluster headaches, are among the most common nervous system conditions. Treating migraine attacks as early as possible is crucial, as symptoms intensify over time, Dr. Cynthia E. Armand, a neurologist and the clinical director at Montefiore Headache Center in New York, told The Epoch Times.
“We know migraine attacks to be a cascade of neuronal signaling that intensifies as time passes,” she said. “The longer we wait to treat, the more time symptoms are allowed to progress to become more severe and potentially more difficult to treat.”
Overmedication is particularly common in chronic headache disorders due to the frequent need for pain relief, “given the need to treat severe disabling headache and associated symptoms as they occur,” Dr. Armand added.
The overuse of pain-relieving drugs is a leading cause of rebound headaches. Medication overuse is defined as taking simple analgesics for 15 or more days or drugs such as triptans, ergots, opioids, or combinations for 10 or more days per month.
Approximately 1 percent to 2 percent of the population experience medication overuse headaches annually, with a higher prevalence among women and those with chronic pain, depression, or anxiety.
Rebound headaches follow a pattern:
- They occur upon waking or soon after.
- Pain improves with medication but returns when it wears off.
- Headaches intensify as the medication wears off.
- Pain relievers become less effective.
Dr. Armand recommends keeping medication readily available and suggests mindfulness and meditation as alternative pain relief methods.
Cardiovascular Concerns With CGRP Inhibitor Risks
Like most drugs, CGRP inhibitors carry risks, including potential serious cardiovascular events.
Recent research published in Frontiers in Neurology suggested that more than 3 percent of the nearly 200 participants taking erenumab (Aimovig) or fremanezumab (Ajovy), both preventive treatments for migraine, developed abnormal electrocardiogram readings or adverse cardiovascular events. More than 1.5 percent of those cases were moderate to severe, leading to treatment discontinuation. Reported events included cerebellar stroke, spontaneous coronary artery dissection (SCAD), and pericarditis (swelling of the tissues surrounding the heart).
While no such observations have been reported for CGRP inhibitor atogepant, manufacturer AbbVie urges caution when prescribing to older patients. The company recommends starting with the lowest effective dose, considering the higher likelihood of decreased liver, kidney, or heart function and potential drug interactions in this age group.