First drug to treat migraine and its pre-existing symptoms

A migraine drug, ubrogepant, has been shown in a clinical trial to also reduce symptoms that occur in the hours before a migraine, such as sensitivity to light and sound, dizziness, difficulty concentrating, and neck pain.

The results, published in the journal Nature Medicine , suggest it could be the first acute treatment for symptoms that occur before migraine and have a significant impact on daily life.

Several symptoms may occur before a migraine, including an aura and premonitory (prodromal) symptoms , also known as early-onset symptoms, such as sensitivity to light and sound, nausea, neck pain, and dizziness.

Although most migraine research has focused on treating the headache itself, no treatment has been shown to be effective in relieving the early premonitory symptoms, which often last for hours and can cause considerable dysfunction in migraine sufferers.

Acute medications are primarily used to treat headaches during the migraine attack itself. However, it has long been known that migraines begin much earlier, often with prodromal symptoms.

"Prodromal symptoms such as sensitivity to light and sound, dizziness, difficulty concentrating, and neck pain have a considerable impact on migraine patients. Light sensitivity is cited as the most bothersome symptom in many studies on migraine attacks. Dizziness and concentration problems have a significant impact on daily performance, for example, in a professional context," Charly Gaul of the Frankfurt Headache Center (Germany) explains to SMC.

Ubrogepant belongs to the family of gepants , drugs that work by blocking a substance in the brain (CGRP) linked to migraine pain. They are well tolerated by most people and may be a good option for those who cannot use other treatments such as triptans.

Peter Goadsby's team at King's College London (UK) analyzed the effectiveness of ubrogepant as a treatment for premonitory symptoms in 438 participants aged 18 to 75 years with at least a one-year history of migraine.

Participants were divided into two groups for a double-blind study and took a 100-milligram dose of ubrogepant or placebo after the initial premonitory symptoms began, during which the participant was certain a headache would occur within 1 to 6 hours.

During a second prodromal episode , at least 7 days later, participants took the opposite treatment (ubrogepant or placebo).

Researchers found that when participants received ubrogepant, they reported improvements in their ability to concentrate 1 hour after treatment, decreased light sensitivity 2 hours after treatment, and less fatigue and neck pain after 3 hours, compared to the placebo group.

Symptoms of dizziness and sensitivity to sound were also reduced in participants treated with ubrogepant between 4 and 24 hours after treatment.

These findings suggest that ubrogepant may be an effective treatment for common premonitory symptoms, with improvements possibly beginning within an hour of dosing.