New Drug May Stop Migraine Attack Before Headache Starts

The drug ubrogepant can stop a migraine attack before a headache starts in patients who can recognize other early signs like sensitivity to light, according to a new study.

At least 39 million Americans have migraine, a debilitating neurological condition that is primarily characterized by headaches but can also cause symptoms like nausea, blurred vision, and fatigue.

CGRP inhibitors, short for calcitonin gene-related peptide receptor antagonists, are among the first-line treatments for migraine. The drugs work by blocking the effect of CGRP, a protein that plays a key role in the migraine process.

A new study published in the journal Neurology tested the effectiveness of ubrogepant (Ubrelvy) taken during the early stages of a migraine attack. Ubrogepant is a CGRP inhibitor, used to treat migraine symptoms but not to prevent the condition.

The study, funded by AbbVie, the maker of ubrogepant, included 518 participants who had migraine for at least one year and two to eight migraine attacks per month in the three months before the study. They all regularly experienced early signs indicating that a migraine attack would be starting within the next few hours, such as sensitivity to light and sound, fatigue, neck pain or stiffness, or dizziness.

The participants were divided into two groups. The first group received a placebo for their first set of pre-headache symptoms, followed by 100mg of ubrogepant for their second instance of symptoms. The second group took ubrogepant after experiencing the first pre-headache symptoms and placebo for the second instance.

Participants evaluated how the migraine attack limits their daily activity in their diary using a scale ranging from zero to five, with 0 meaning “not at all limited – I could do everything”; 1, “a little limited”; 2, “somewhat limited”; 3, “very limited”; or 4, “extremely limited.”

People who took ubrogepant were 73% more likely to report no disability and be able to function normally two hours post-medication compared to those who took the placebo.

Richard B. Lipton, MD, of Albert Einstein College of Medicine in Bronx, New York, and Fellow of the American Academy of Neurology, and the study author, said taking ubrogepant on time may improve the quality of life for those living with migraine.

Based on our findings, treatment with ubrogepant may allow people with migraine who experience early warning signs before a migraine occurs to quickly treat migraine attacks in their earliest stages and go about their daily lives with little discomfort and disruption.

Lipton

However, the findings apply only to patients who can reliably predict an upcoming migraine attack based on early warning signs.

Moreover, participants recorded their symptoms and medication use in electronic diaries, raising the possibility that some people may not have recorded all the information accurately.

CGRP inhibitors for migraine treatment

The major migraine patient organizations in the United States consider CGRP inhibitors a first-line option for migraine prevention.

There are two types of CGRP inhibitors:

• CGRP monoclonal antibodies (MABs) are used for migraine prevention and include medications like erenumab (Aimovig) and fremanezumab (Ajovy).
• CGRP receptor antagonists (gepants) are used both to stop and prevent migraine attacks. They include rimegepant (Nurtec) and ubrogepant (Ubrelvy), among others.

The medications are highly effective but may be more expensive than other treatments. For example, the annual cost of preventive therapy with generic propranolol (Inderal) is $1,400, compared with up to $10,000 for 12 doses of monthly galcanezumab (Emgality) injections.

Ubrogepant may help stop a migraine attack even before a headache starts, but only in individuals who can recognize early signs of migraine.