Migraine, a drug reduces symptoms preceding the attack

An approved migraine drug called ubrogepant, which can stop the onset of an attack, may also ease debilitating symptoms such as fatigue, brain fog, and sensitivity to light that typically occur before a migraine attack, according to a Phase III clinical trial published in the journal Nature Medicine.

The drug is the first to be shown to also be effective against the "prodromal" symptoms that occur hours or even days before an attack, and could therefore "free patients from a disabling part of migraine," says study co-author Peter Goadsby of King's College London.

Migraine begins long before the headache. In the prodrome, or premonitory phase, people may experience a variety of unpleasant symptoms, including fatigue, neck pain, photophobia or phonophobia, and difficulty concentrating.

The study included 438 participants who could reliably identify incoming migraine attacks by their prodromal symptoms. Participants took either ubrogepant or a placebo whenever they felt prodromal symptoms coming on.

The results suggest that for some participants the drug increased the ability to concentrate one hour after treatment, reduced photophobia two hours after treatment, and reduced fatigue and neck pain after three hours.

But the "effect sizes were small," never exceeding 15 percentage points over the placebo. For example, 27 percent of participants taking ubrogepant reported no fatigue, compared with 17 percent of those taking the placebo.

However, this study answers the question of whether ubrogepant works when given early in the course of migraine, when prodromal symptoms are felt. Of course, it’s crucial that participants could predict their prodromal symptoms. “People who know about migraine would benefit most from this drug,” Goadsby says. The next challenge for the field, he adds, is to train people to understand migraine symptoms so they can assess when to take ubrogepant.