Migraine Preventive Medications for Migraine

This trial aims to determine which of the three migraine preventive medications—atogepant, topiramate, or propranolol—works best and is easiest to tolerate for preventing migraines. Participants will receive one of these medications at random and will track their migraine patterns using a headache diary. Suitable candidates have experienced migraines for over a year, have at least four days of moderate to severe headaches each month, and are open to trying a new preventive medication. As a Phase 4 trial, this research helps to understand how these FDA-approved treatments benefit a broader patient population.

If you are already taking a migraine preventive treatment, you can continue with it without changing the dose during the first 16 weeks of the study. However, you cannot currently be taking atogepant, propranolol, or topiramate, or any CGRP-targeting preventive medication or beta-blocker.

Research has shown that atogepant is generally safe and effective for preventing migraines, significantly reducing the number of migraine days. Common side effects, such as nausea and tiredness, are mild for most people.

Propranolol, another common medication for migraine prevention, has been used safely for many years. Some individuals might experience tiredness or dizziness, but these effects are usually manageable.

Topiramate is also a well-known option with a good safety record. It is typically well-tolerated, though some individuals might experience tingling in their hands and feet or notice changes in taste. These side effects are generally mild.

Researchers are excited about these treatments because they offer unique approaches to migraine prevention. Atogepant is a CGRP receptor antagonist, which works differently from typical migraine drugs by blocking a protein involved in migraine attacks, potentially offering fewer side effects and better tolerance. Propranolol, although a long-standing treatment, is being re-evaluated for its effectiveness and safety in higher doses for migraine prevention, which could optimize its use. Topiramate, another established option, is being tested to refine dosing strategies, aiming to minimize side effects while maintaining its preventive benefits. Each of these treatments brings a distinct approach, potentially broadening the options for individuals seeking relief from migraines.

Research shows that atogepant, one of the treatments in this trial, reduces the number of migraine days. Studies find it lowers migraine frequency more than a placebo and is generally well tolerated. Propranolol, another treatment option in this trial, also has strong evidence supporting its use in preventing migraines. A review of 58 trials showed that propranolol significantly reduced migraine frequency compared to a placebo. Topiramate, the third treatment in this trial, is another option, with many studies showing it effectively reduces headache frequency. It is generally considered safe and effective for many patients. Each of these medications has been shown to prevent migraines, though they may work differently for different people.²⁴⁶⁷⁸