- A new study proves that preventive migraine medication can help avoid ‘rebound’ headaches.
- The medication is effective enough to reduce the need for additional painkillers that can cause rebound headaches when taken.
- The drug, atogepant, relaxes the blood vessels where migraine attacks begin, preventing them from becoming too large and irritating the meninges at the base of the skull, causing the throbbing pain associated with migraines.
Medications used to prevent migraines may also help reduce so-called rebound headaches, according to a new review of data from randomized, double-blind, placebo-controlled migraine trials.
Taking the drug atogepant daily can reduce the pain associated with migraines and the need for additional painkillers, which are thought to cause rebound headaches.
The study was led by headache specialists. Peter J. Goadsby, MBBS, MD, PhD He is a professor at King’s College London and a member of the American Academy of Neurology.
The findings have been published in the journal Neurology. Neurology.
The trial involved 755 participants, all of whom suffered from chronic migraines. Each participant experienced at least 15 headache days per month, at least 8 of which were migraine days.
Overall, 66% overused painkillers, a common occurrence when trying to relieve headaches.
They were taking simple painkillers such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or acetaminophen at least 15 days per month. Triptans or ergot alkaloids for at least 10 days, and some took a combination of both for at least 10 days over the course of a month.
The study began with a 4-week screening/baseline period.
At the start of the study, participants suffered from migraines on an average of 18 to 19 days per month and took painkillers 15 to 16 days per month.
The subjects were then randomly assigned to receive 30 milligrams (mg) of atogepant twice daily, 60 mg of atogepant once daily, or a placebo for 12 weeks. During this period, their use of painkillers was monitored.
Participants who took atogepant took fewer days of pain medication during the study. Additionally, a higher percentage of participants taking atogepant experienced a 50% or greater reduction in rebound headaches per month.
In general, Goadsby says: “[m]Migraine is a genetic brain disorder whose attacks are triggered by changes in the brain and the external environment.”
“We know the physiological pathways, but we don’t know what causes migraines because the triggers are different for different people.” Clifford Seguill, D.O.“The results are surprising,” said a neurologist at Providence Saint John’s Health Center in Santa Monica, California, who was not involved in the study. Today’s Medical News.
“For example, red wine drinkers are more likely to suffer from headaches than white wine drinkers. And cheese drinkers are more likely to suffer from headaches. Caffeine can both trigger and cure headaches. So we still don’t fully understand what causes headaches,” he says.
Modern drug treatments for migraine attacks can be divided into two categories: preventive and rescue. Atogepant is strictly a preventive medication, but it is closely related to two other medications, ubrogepant and rimegepant, which are rescue and combined preventive/rescue medications.
“Atogepant is a preventative medication for migraines,” Goadsby says. “When taken daily, it reduces migraines and greatly reduces the need for acute treatments like painkillers. It actually stops the attack before it starts.”
This drug is ” [involved] “Your blood vessels narrow, they become less wide, and when they narrower, you feel better,” Segill explained.
Goadsby also explained rebound headaches and why they occur. He said:
“A rebound headache occurs when the medication you took to relieve an attack wears off and the headache returns. Let’s say you have a migraine that lasts two days. If you take a medication on the first day that lasts for 24 hours, the headache will return (rebound) the next day and you will need to get a different treatment.”
“A big problem with migraines is taking too much medication, so you can get what’s called a ‘medication overuse headache’ or a ‘rebound’ headache. The simplest example is when you take Motrin, Advil or Aleve when you’re in pain. [or some other] “I take an NSAID every day,” Segill explained.
Goadsby also warned that taking painkillers such as NSAIDs frequently can cause stomach ulcers and other damage to the digestive tract.
“Taking painkillers can paradoxically increase the number of migraine days in patients with so-called medication-overuse headache, so reducing the dose of painkillers could prevent this from happening,” he said.
Overuse of painkillers can negate the chance of a migraine attack getting better, Segill said.
A migraine is a severe headache characterized by a throbbing, pulsating pain that can cover half of the head.
It may be accompanied by an unpleasant sensitivity to bright lights or loud noises (photophobia or phonophobia, respectively), with or without blurred vision or visual auras (a hard-to-describe symptom in which vision becomes prismatic).
“Typically, when you have a migraine, there are blood vessels called meninges between the brain and the skull, and when these blood vessels become too large, they expand and pull on the meninges. [which is] “It’s the brain’s shock absorber, and that’s what often causes the throbbing pain,” Segill explained.
“The cortex of the brain is then stimulated, creating an electrical wave called cortical spreading depression, which usually translates into radiating pain,” he elaborated.
