New migraine drug stops symptoms before headache even begins

MINNEAPOLIS – Migraines affect over one billion people worldwide, causing debilitating headaches and other symptoms that can severely impact quality of life. A new study suggests that taking medication at the earliest signs of an impending migraine – before the headache even begins – may help prevent symptoms and allow people to function normally.

The study, published in the journal Neurology, examined the effects of a migraine medication called ubrogepant when taken during the “prodrome” phase – the period before a migraine headache starts when people often experience warning signs like fatigue, neck stiffness, or sensitivity to light.

This research represents an innovative approach to migraine treatment. Traditionally, patients have been advised to take medication once the headache pain begins. However, by that point, the migraine process is well underway. Treating during the prodrome may potentially stop the migraine in its tracks.

“Migraine is one of the most prevalent diseases worldwide, yet so many people who suffer from this condition do not receive treatment or report that they are not satisfied with their treatment,” says study author Dr. Richard B. Lipton, of Albert Einstein College of Medicine in New York, and Fellow of the American Academy of Neurology, in a statement. “Improving care at the first signs of migraine, even before headache pain begins, can be a key to improved outcomes. Our findings are encouraging, suggesting that ubrogepant may help people with migraine function normally and go about their day.”

The researchers conducted a clinical trial involving 518 adults who experienced two to eight migraine attacks per month. Participants were instructed to take either ubrogepant or a placebo when they experienced prodrome symptoms and felt confident a headache would follow within one to six hours.

Results showed that those who took ubrogepant were significantly more likely to report being able to function normally over the next 24 hours compared to those who took the placebo. As early as 2 hours after taking the medication, more ubrogepant users reported having “no disability” and could function normally.

The rapid onset of action for ubrogepant was noteworthy. Even before a headache would typically develop, patients were reporting benefits in terms of their ability to go about their daily activities.

The study also found that ubrogepant users experienced fewer limitations on their activities over 24 hours and were more satisfied with their treatment compared to those who took the placebo.

Interestingly, the researchers noted that when participants took the study medication during the prodrome, about 75% were already experiencing some degree of functional limitations — even before any headache pain began. This observation highlights how disruptive the prodrome phase can be. Symptoms like fatigue, neck pain, and sensitivities to light or sound were impacting people’s ability to function normally, even in the hours before the headache onset.

Ubrogepant belongs to a relatively new class of migraine medications called gepants, which work by blocking a protein in the body called calcitonin gene-related peptide (CGRP). CGRP is believed to play a key role in the cascade of events that leads to migraine attacks.

The medication is already FDA-approved for treating migraine headaches once they’ve begun. This new study suggests it may also be effective when taken preemptively during the prodrome phase.

The ability to treat a migraine before the headache even starts could be game-changing for many patients. Early intervention may potentially stop the migraine process and prevent hours or days of pain and disability.

The researchers noted that one challenge is that not all migraine sufferers experience a clear prodrome or may not be able to reliably predict when a headache will follow prodromal symptoms. In this study, they specifically enrolled participants who said they could confidently predict an impending migraine based on prodrome symptoms at least 75% of the time.

Recognizing individual warning signs requires practice and awareness for patients. However, for those who can reliably identify their prodrome, this preemptive treatment approach could be very beneficial.

The study authors emphasized that more research is still necessary to fully understand the long-term efficacy and safety of taking migraine medication during the prodrome. However, these initial results are promising and could lead to new recommendations for migraine treatment.

Migraine is the second leading cause of disability worldwide. Any advances that can help reduce that burden are incredibly important. This study suggests that early treatment during the prodrome could be a valuable new tool in the arsenal against 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,” says Lipton. “This could lead to an improved quality of life for those living with migraine.”