Menu

American Headache Society

QULIPTA (Atogepant) Recent Reports

, 0

It’s about time to have an update on QULIPTA, otherwise known as atogepant, a newer migraine preventative.

Atogepant (QULIPTA)

You may remember that we were talking about atogepant back in 2020. At a time when many medications were coming out as injections, atogepant was a bit of a breath of fresh air. A preventative, taken orally, and only taken once a day (10, 30 or 60mg), with or without food. Much more convenient even than many other oral preventatives.

Atogepant was approved by the FDA in 2021, but studies continue. QULIPTA came up at the June 2022 American Headache Society 64th Annual Scientific Meeting a number of times, and we’re learning more about it as it begins to be used more in the general population.

For example, it was found that some patients seem to lose weight when taking atogepant. It’s a minority, but still a significant number. Not only were patients less likely to gain weight, some actually lost weight taking the medication. Something to watch.

It was confirmed once again that you can take atogepant with or without food. The difference seems to be negligible.

It seems that although many patients find their symptoms diminishing in the first month of treatment, others do need to wait 2 or even 3 months before atogepant works for them. And so far, patients taking the preventative for a year seem to still benefit (we’ll keep watching this – remember, the medication is very new!).

A patient who took the COVID-19 mRNA vaccine experienced continuous migraine visual aura, and was successfully treated using atogepant. This may be a useful treatment for migraine symptoms after vaccination, another one to watch.

More studies have been done on the overall safety of QULIPTA. So far, the news is good – it seems to be generally safe. However, as with any medication, it is very important to tell your doctor about any supplements, medications, vitamins, and so on, that you may be taking. This may affect your dosage.

For more information about atogepant, visit the official QULIPTA site here.

Did You Quit Your CGRP Preventative Too Soon?

1

Typically, it seems to be a good idea to try any new treatment for three months. But a new study from Italy is suggesting that some patients may be quitting certain treatments too soon.

In this case, we’re talking about CGRP inhibitors that are used as migraine preventatives.

The study was presented at last month’s annual American Headache Society meeting. The study followed patients who were taking anti-CGRP medication for 48 weeks (about 11 months). The overwhelming majority of patients did indeed respond to the medication within 12 weeks. But depending on the medication, between 7.6% and 15.5% responded in weeks 13-48, the median time of response for the “late responders” being 20 weeks, or about 4.5 months.

Studies like this, though preliminary, raise some interesting issues. Dr. Deborah Friedman (from the University of Texas Southwestern Medical Center), quoted in an article in Neurology Today, gives her response to some of the online chatter that’s been happening:

There are colleagues of mine who said anybody who would keep somebody on a medication that didn’t work longer than three months, it’s unethical. Well, I keep my patients on it for four to six months and that’s what we did with Botox, because I’ve seen people respond late.

Dr. Deborah Friedman

Unethical? Why unethical?

Think about it. Even if there are a few people who may respond late, your chances of responding to the medication do significantly drop after 12 weeks. So if every patient is now put on a trial of 20 weeks or more (some are suggesting 6 months to a year), the drug company selling the product certainly benefits. The insurance company may not be so sure. And most of the people taking the medication for those extra weeks will never benefit from it, and so are only dealing with any side effects with no benefit at all. That’s the cold number crunching.

But the fact remains that some patients may be missing out because they’re only trying the medication for 12 weeks.

All right then, is there a way we could identify those patients – the ones that will benefit eventually – thus improving the odds?

The study has perhaps started to point the way. The researchers did note some tendencies among the late responders:

  • More likely to have a higher average body mass index
  • Slightly less likely to have one-sided pain with allodynia (more on this below)

Of course, this works both ways. If you have one-sided pain with allodynia, you may be a little more likely to benefit from an anti-CGRP preventative. Because basically the late responders were simply a little more like the non-responders.

This is a long way from a way to identify which patients will respond late. But what the study does tell us is that we should be looking closer to find out how we can identify those patients – it shows us that there may be a way, eventually.

Right now, it’s probably best to have a good relationship with a specialist you trust, and let them help you decide if it’s worth it to try your medication (or other treatment) for longer. They know you best, and know your medical history.

To delve further into this topic, check out the article at Neurology Today by Thomas R. Collins: Late Migraine Responses Seen for Anti-CGRP Therapy

Also the National Headache Foundation has put out a video on the optimistic side, explaining this study:

Childhood Headache Increasing?

0

Last year, Dr. Marc DiSabella of Children’s National Hospital shared a report at the American Headache Society Virtual Annual Scientific Meeting regarding headache in children between the summer of 2020 and the winter of 2021. Although the report as seen online may raise more questions than it answers, it does give us a lot of food for thought.

Sad girl at computer

Regarding headaches, researchers found that episodic headaches tended to decrease over this time, but that chronic and daily headaches increased. Nearly half of the patients said that their headache symptoms worsened. 12% said that their stress levels went down, whereas about half experienced worse stress and anxiety.

A further breakdown of information would be interesting. For example, most children reported that they ate and drank more over that time. Don’t you want to know – did they drink more water? Milk? Soft drinks? That question could make a drastic difference.

When did they eat? Snacks? Meals? And what was the difference between those who ate more, and those who ate less? For example, for some poorer children, the only half-decent meal they had many days was at school. So many children home from school due to COVID-19 restrictions found their nutrition decrease, not increase.

A CDC reported on weight gain:

…the rate of body mass index (BMI) increase approximately doubled during the pandemic compared to a prepandemic period. Persons with prepandemic overweight or obesity and younger school-aged children experienced the largest increases.

Longitudinal Trends in Body Mass Index Before and During the COVID-19 Pandemic Among Persons Aged 2–19 Years — United States, 2018–2020

Doubled! And this study once again confirms that problems we had in 2019 tended to get worse by 2021.

More than half of children reported less physical activity, and 62% said that added screen time contributed to their headaches.

This report does tell us some things. Yes, many chronic headaches did get worse, and this certainly may relate to a lack of exercise. But every situation was different. And some differences could be the involvement of parents, opportunities in the community, economic levels, and so on.

A recent article at Akeso Health Sciences reported on this study and others. Like anything else, the changes and instability that children have been experiencing over the past 2 years bring risks. In other words, some children may have thrived, others not so much. But it helps when parents are aware of the risks and finding ways to mitigate them.

Are children eating nutritious meals? Getting exercise out of doors? Do you notice changes in symptoms (headaches, stomach problems, paleness, irritability)? How about mental health? Are families finding creative, fun, and educational things to do together?

Is This Why Aimovig Won’t Work For You?

, 0

Aimovig (erenumab) has been a great help for many migraine patients, but not all. Do we know of any reasons why it doesn’t work with some people?

Different medications - problems together?

A good doctor doesn’t want to randomly throw medications in your direction, trying on after the other. A good doctor knows which drugs have good scientific evidence behind them, and if possible which seem to work best for a patient like you – perhaps someone with your symptoms, or your lifestyle, or your medical history.

Now we all know that each person is very different and complex, so we will never type in “10 facts about Me” and have the computer spit out the perfect treatment. But we do have some clues once in a while that help us choose one treatment over the other.

Last year at the 62nd Annual Scientific Meeting of the American Headache Society, a report was presented entitled “CGRP Monoclonals: Efficacy, Side Effects, and Switching”. It attempted to start answering questions about which CGRP related medications were good for whom, and whether or not a patient should consider switching. Another concern is that more side effects were showing up in the real world than had shown up in clinical trials (not uncommon, but something to watch).

There were a couple of interesting notes in particular regarding erenumab, brand name Aimogvig.

First, and not surprisingly, patients with “moderate or severe refractory chronic migraine” were less likely to be helped. That is, those with significant chronic migraine that has not responded to several other common treatments. However, if patients had “mild refractory chronic migraine”, the medication may help.

The second predictor that Aimovig may not work was that the patient was taking opioids.

Opioid medications have helped many migraine patients, but must be used with extreme care because they are notorious for making the migraine condition worse. Occasional or very temporary use may be helpful for pain, but there are usually better options.

So for some reason, patients taking opioids were less likely to benefit from erenumab. This raises an interesting question – if patients stopped taking opioid medications for several months, might they be able get more benefit from Aimovig? Or, if they stopped taking opioids upon starting Aimovig, would symptoms improve several months later?

For the average patient, the study found that most patients could tell after a couple of months if Aimovig was going to be worth it for them. (A good rule of thumb for most treatments is to try them for three months.)

And what about trying a different but similar medication? In this small study, there did not seem to be a general benefit – but remember, for an individual, it may be worth it. The study did note that some patients did switch because of financial reasons, and “more than half of the patients did well”.

CGRP Medication Side Effects – “I hadn’t thought of that…”

, 0

One of the things patients like about CGRP related migraine medications is that the side effects are often less than with other drugs. But there can be side effects.

Calendar clock
Side effects – mostly temporary…?

A recent study used a checklist to see if patients would notice other side effects that weren’t so obvious, or that they might not think of right away. The researchers were concerned that some of these were missed in some of the original trials.

This particular study was presented at the 62nd Annual Scientific Meeting of the American Headache Society, and came from the Chicago Medical School and Robbins Headache Clinic. 119 chronic migraine patients were first asked about side effects generally, and then they were handed a checklist.

The study itself is arguing for the use of checklists to identify side effects, but for us it is interesting to see which adverse effects were noticed using the checklist.

These patients had been on therapy for two months. What about you? If you’ve taken a CGRP related drug, have you noticed any of these? Here are the most commonly reported ones:

  • Constipation
  • Anxiety
  • Injection site reaction/irritation
  • Insomnia
  • Hair Loss
  • Muscle Pain/Cramps
  • Joint Pain
  • Irritability
  • Increased Headache
  • Depression
  • Nausea

Again, remember that generally speaking side effects from these medications have been mild. Some also go away with time. For example, many patients experience increased headache for a few days or a couple of weeks, but then start to feel better. Weight gain lasted from 1-4 months. Of course injection site reactions were usually very brief.

However, some symptoms could be ongoing, so do check with your doctor. Hair loss, constipation, and sexual dysfunction, for example, seem to last longer (but again, many people have no problems whatsoever).

What’s been your experience?

(Study abstract here (scroll down): CGRP Monoclonal Adverse Effects: Evaluation Via Use of a Checklist

Load More

Back To Top
The articles on Headache and Migraine News are © 2004-2024 J. Cottrill.
Every effort is made to ensure the accuracy of each article, and to point you to further sources of information. However, this site is for informational purposes only and should never replace a visit to your doctor.