From the Guidelines
Rebound Migraine after Stopping Qulipta (atogepant)
Rebound migraine is a potential risk after stopping or reducing the dose of certain migraine preventive medications, including Qulipta (atogepant) [ 1 ].
- Definition and Risk: Rebound migraine, also known as medication overuse headache, is associated with the withdrawal of analgesic drugs or abortive migraine medications [ 1 ].
- Mechanism and Comparison: The risk of rebound migraine is thought to be lower with Qulipta compared to other migraine preventive medications, such as triptans or ergots, due to its distinct mechanism of action as a calcitonin gene-related peptide receptor antagonist.
- Guidelines and Precautions: Patients who have been taking Qulipta 10-30 mg orally once daily for an extended period, typically 3 months or longer, may experience rebound migraine upon discontinuation [ 1 ].
- Clinical Considerations: Although there is no uniform agreement about which agents can cause rebound headache, it is generally thought that rebound headaches can be caused by opiates, triptans, ergotamine, and analgesic medications that contain caffeine, isometheptene, or butalbital [ 1 ].
- Prevention and Management: To minimize the risk of rebound migraine, it is essential to consider the possibility of rebound headaches when discontinuing Qulipta or other migraine preventive medications, and to develop a plan for managing potential withdrawal symptoms [ 1 ].
From the Research
Rebound Migraine after Stopping Qulipta (atogepant)
- Rebound migraine, also known as medication overuse headache (MOH), is a condition that can occur when medication is overused to treat headaches 2, 3, 4.
- The risk of MOH is associated with the frequent use of certain medications, including triptans and opioids 2, 3.
- Gepants, a class of medications that includes atogepant, have shown efficacy and safety in clinical trials for the treatment of migraine, with a low risk of MOH 3, 5.
- Atogepant, in particular, has shown efficacy in migraine prevention and is unlikely to lead to MOH due to its mechanism of action as a calcitonin gene-related peptide receptor antagonist 5.
- The management of MOH typically involves discontinuing the overused medication, instituting preventive therapy, and providing patient education 2, 6, 4.
- Studies suggest that gepants, including atogepant, may have a lower risk of MOH compared to other medications, making them a potentially useful treatment option for patients with migraine 3, 5.