Does Ubrevely cause rebound headaches?

Ubrelvy (Ubrogepant) and Rebound Headaches

Ubrelvy (ubrogepant) does not appear to cause rebound headaches or medication-overuse headaches when used as directed, unlike many traditional migraine medications. 1

Understanding Medication-Overuse Headache

Medication-overuse headache (MOH), also called rebound headache, is a secondary headache disorder that can develop from frequent use of acute headache medications. This condition is characterized by:

• Increasing headache frequency and intensity despite increasing medication use 2, 3
• Development when acute medications are used more than 10-15 days per month (depending on medication type) 2, 4
• Occurs only in patients with pre-existing migraine or tension-type headache 3

Risk Factors for Medication-Overuse Headache

Not all migraine medications carry the same risk for causing rebound headaches:

• Highest risk: Medications containing barbiturates, caffeine, butalbital, or opioids 2, 5
• Moderate risk: Ergotamine derivatives and triptans 2, 3
• Lower risk: NSAIDs (when used less than 15 days/month) 2, 5
• Minimal evidence of risk: Newer CGRP antagonists like Ubrelvy (ubrogepant) 1

Why Ubrelvy Has Lower Rebound Risk

Ubrelvy (ubrogepant) belongs to a newer class of migraine medications called calcitonin gene-related peptide (CGRP) receptor antagonists that appear to have a more favorable profile regarding medication-overuse headache:

• High specificity and selectivity for CGRP receptors 1
• Different mechanism of action than traditional migraine medications that are known to cause rebound 1
• Clinical trials have shown good tolerability and favorable safety profile 1

Prevention of Medication-Overuse Headache

To minimize any potential risk of developing medication-overuse headache:

• Limit use of any acute migraine medication, including Ubrelvy, to fewer than 10 days per month 2
• Consider preventive migraine therapy if headaches occur more than 2 days per week 2, 6
• Use a headache diary to monitor frequency of medication use 2
• Avoid anticipatory medication use (taking medication before headache occurs) 3

Management Approaches

If medication-overuse headache is suspected:

• The primary approach is cessation of the overused medication 3
• A three-step approach is recommended:
  • Bridging or transition program (may include short-term corticosteroids) 3, 7
  • Implementation of non-pharmacological measures 3
  • Early initiation of preventive medication after discontinuation of overused medication 3

Important Considerations

• The concept of medication-overuse headache has been questioned by some researchers who suggest that frequent medication use may be a marker of poorly controlled headaches rather than always being causative 8
• Individual response to medications varies significantly, and treatment should be tailored based on headache characteristics, frequency, and associated symptoms 2
• Migraine-specific therapies like Ubrelvy should be considered early in treatment rather than relying on non-specific analgesics 3

Clinical Recommendation

For patients with migraine, Ubrelvy can be used as directed without significant concern for developing rebound headaches, though general principles of limiting acute medication use to fewer than 10 days per month should still be followed. 2, 1