Another Weapon against “Rebound Headache”?
A major concern among migraine patients (and their doctors) is what we sometimes call “rebound headache” or “medication overuse headache”. The perhaps over-simplified idea is that taking “too much” medication may make your headache symptoms come back worse than ever, or more frequently.
But this explanation can be misleading, partly because the whole concept remains very controversial. Just which medications lead to more headaches? And if migraine medication “causes” migraine, what’s the treatment?
In spite of a lot of misunderstanding regarding these types of migraine attacks, the ultimate goal really isn’t to take “less medication”. The goal is – you guessed it – less migraine! If you’re taking a painkiller or migraine medication and your symptoms are worsening over time, it may simply be time to try something different. Even if you end up taking more pills, you may be able to start a trend of fewer and fewer headaches.
How so? For example, if you find yourself taking a painkiller or more every single day, and your headaches are only getting more severe as the months pass, not to mention side effects from the medication, one option is to try a daily preventative – something that has been tested properly specifically as a daily medication.
Though information is limited about certain types of medication for certain types of migraine, every once in a while a study comes out that prioritizes a certain kind of medication for a certain type of migraine – such as rebound or medication overuse. And that’s the case with a study published in the journal Neurology last month.
The drug is atogepant, a calcitonin gene-related peptide receptor antagonist, sold under the brand name QULIPTA (you can read more about atogepant here). It’s a preventative taken orally each day. And in spite of the fact that rebound type migraine attacks are notoriously difficult to treat, atogepant seems to make a significant difference.
In the study, patients took one or two dose per day (it was the same amount either way – 60mg total). Patients had 2-3 few days a month with migraine, and 3 fewer days with other medications. For those with medication overuse headache, that means about a 50% reduction in headaches for almost half of the patients. Many of the patients actually no longer met the official criteria for medication overuse headache by the end of the study.
The best results overall came for patients spreading out the daily preventative in two doses.
Once again, this is not a silver bullet that works for everyone. But the results are very good considering how difficult this type of condition can be to treat. Study author Dr. Peter J. Goadsby notes:
Based on our findings, treatment with atogepant may potentially decrease the risk of developing rebound headache by reducing the use of pain medications. This could lead to an improved quality of life for those living with migraine.
Dr. Peter J. Goadsby
This is one of those clinical trials that, although preliminary, can be useful immediately. Any medication showing positive results for medication overuse is worth moving up the list for those who are struggling with increasing headache and migraine symptoms.
You can read more about the study here: Could preventative drug be effective in people with migraine and rebound headache? The study itself is here: Efficacy of Atogepant in Chronic Migraine With and Without Acute Medication Overuse in the Randomized, Double-Blind, Phase 3 PROGRESS Trial