Migraine can be debilitating. However, a new drug, atogepant, which is taken orally, promises efficacy for the condition. But how effective is it? Dr PN Renjen, senior consultant, neurology, Indraprastha Apollo Hospitals, says: “Atogepant is a promising oral medication for the preventive treatment of migraines. It is a calcitonin gene-related peptide (CGRP) receptor antagonist, specifically designed to reduce the frequency of migraine days.
Clinical trials, such as the advance and elevate studies, demonstrated significant efficacy in reducing monthly migraine days (MMDs) and improving functional outcomes within just weeks of treatment. In particular, atogepant showed early benefits, with reductions in weekly migraine days and improved quality-of-life measures during the first month of use. It is effective for both episodic and chronic migraines and provides an alternative to injectable treatments, making it more accessible for some patients. Additionally, it has been shown to help with medication-overuse headaches caused by excessive use of other pain-relief drugs. Overall, atogepant represents a significant advancement in migraine prevention due to its efficacy, tolerability, and convenience as an oral medication.”
Can it be taken over the counter?
Atogepant cannot be taken over-the-counter (OTC). It is a prescription medication approved for the preventive treatment of migraines and requires a healthcare provider’s evaluation before use. The drug has specific indications and dosing requirements that must be tailored to individual patient needs based on their migraine history and response to previous treatments.
Furthermore, access may involve insurance approval processes, as atogepant is often recommended for patients who have failed other preventive therapies. Unlike OTC analgesics such as ibuprofen or aspirin, atogepant targets CGRP receptors specifically, making it unsuitable for self-medication without medical supervision.
Who is a candidate for the drug, and who is not?
Candidates for atogepant include adults with episodic or chronic migraines who experience frequent monthly migraine days (4-14 MMDs for episodic migraines or 15 headache days for chronic migraines). It is particularly recommended for individuals who have not responded to three or more other preventive treatments or cannot tolerate injectable therapies. However, certain groups are excluded from its use. These include individuals with severe liver impairment, those who use opioids or barbiturates excessively (4 days/month), and patients who have failed more than four classes of preventive treatments. Additionally, clinical trials primarily involved adults aged 18-80 years with no significant comorbidities; thus, pediatric patients or those with complex medical conditions may not be ideal candidates without further research.
Migraines can be managed through non-pharmacological approaches that focus on lifestyle modifications and behavioural interventions.
These include:
- Stress management: Techniques like mindfulness, meditation, yoga, and cognitive-behavioural therapy can reduce stress triggers.
- Dietary changes: Avoiding common triggers such as caffeine, alcohol, and processed foods may help.
- Sleep hygiene: Ensuring consistent sleep patterns can lower migraine frequency for patients.
- Hydration: Staying well-hydrated will prevent dehydration-induced headaches for patients.
- Physical activity: Regular aerobic exercise has been shown to reduce migraine frequency.
- Acupuncture: Some studies also suggest that acupuncture may help alleviate symptoms.
- Biofeedback: This technique trains individuals to control physiological responses that trigger migraines.
These strategies are often used in conjunction with preventive medications or as standalone approaches for individuals who prefer non-drug options.