A recent clinical trial found that taking ubrogepant during the early phase of a migraine attack—prior to the onset of a headache—could reduce several common symptoms such as sensitivity to light, fatigue, neck pain, and trouble concentrating.
In the study, researchers included 477 participants who could reliably identify prodromal symptoms of a migraine, which often appear hours before headache onset. These symptoms included tiredness, neck stiffness, dizziness, and cognitive difficulties.
The researchers tested whether a 100-mg dose of ubrogepant, a calcitonin gene-related peptide receptor antagonist already approved for migraine treatment, could alleviate these symptoms when taken during the prodromal phase. The participants were assigned to take either ubrogepant or a placebo for two separate migraine events and recorded symptoms over 48 hours.
Ubrogepant consistently outperformed placebo in relieving symptoms. At 3 hours postdose, 27.3% of ubrogepant-treated events were free of fatigue vs 16.8% for placebo. Similarly, 28.9% of ubrogepant users reported no neck pain compared with 15.9% of placebo users.
Cognitive symptoms also showed early improvement. At 1 hour, 8.7% of ubrogepant users reported no difficulty concentrating vs 2.1% in the placebo group. At 6 hours, 56.9% reported no difficulty thinking compared with 41.8% on placebo.
Photophobia, the most common prodromal symptom, was reported at baseline among 61% of participants. Two hours posttreatment, 19.5% of ubrogepant users no longer had photophobia compared with 12.5% of those on placebo.
Other symptoms also improved. At 4 hours, 50.7% of ubrogepant users reported no phonophobia compared with 35.8% of those in the placebo group. At 24 hours, dizziness had resolved in 88.5% of ubrogepant-treated events vs 82.3% of those receiving placebo.
Use of rescue medication within 24 hours was lower in the ubrogepant group (21.7%) compared with in the placebo group (39.4%).
No serious adverse events were reported. The most common treatment-emergent side effects were mild and included nausea (5% vs 3%), fatigue (3% vs 2%), and dizziness (2% vs 3%) in the ubrogepant and placebo groups, respectively.
“Treatment with ubrogepant during the prodromal phase may ameliorate common prodromal symptoms, with improvements possibly as early as 1 h[our] post-dose,” said lead study author Peter J. Goadsby, of the National Institute for Health Research King’s Clinical Research Facility at King’s College London, and colleagues.
The study followed a randomized, double-blind, placebo-controlled, crossover design and was conducted across 75 research centers and headache clinics in the United States. Each participant served as their own control by receiving both placebo and ubrogepant during the trial.
Full disclosures and conflict-of-interest statements are available in the published report.
Source: Nature Medicine
