Even before the headache begins, migraine patients often suffer from pre-boting symptoms: they are sensitive to light and noise, it is difficult to concentrate, have a stiff neck or suffering from symptoms such as dizziness and nausea. Now a study suggests that the migraine medicament Ubrogepant, which has already been approved in the USA, could also help against these early symptoms. However, the results still have to be checked in further studies.
A migraine attack often puts people out of action for hours to days- not only that the headache itself, but also through so-called Prodromal symptoms, which often occur several hours before the actual attack begins. These include sensitivity to light and noise, nausea, neck pain, tiredness and dizziness. Previous migraine medicaments are usually only used when the headache begins. On the other hand, there has been no approved treatment against early symptoms.
However, the Prodrome study published in 2023 had already shown that the drug Ubrogepant, which is approved in the USA for the treatment of acute migraine attacks, also helps if it is taken a few hours before the headache begins. The study participants had to prove in advance with the help of a prospective diary that they can reliably predict their migraine attacks. For the actual study, they were instructed to take a tablet one to six hours before the headache began, which contained either 100 milligrams of Ubrogepant or a placebo. In fact, 46 percent of the subjects who had taken the real medication reported that no headache occurred afterwards. In contrast, it was only 29 percent in the placebo group.
Also against early signs
But does the early intake also affect the pre-Boten symptoms of migraines? To answer this question, a team around Peter Goadsby from King’s College London has now analyzed the results of the Prodrome study. Because even if the primary question of the study was to what extent migraine attacks could be prevented by taking early, the test subjects also answered questions about their further symptoms, including the typical Prodromal symptoms.
And indeed: “The results suggest that Ubrogepant can help with early use that the usual Prodromal symptoms disappear,” report GOADSBY and his colleagues. For example, 19.5 percent of those affected felt less sensitive to light two hours after taking Ubrogepant, in the place bogrup it was only 12.5 percent. Other complaints such as neck problems, fatigue, difficulties of concentration and sensitivity to noise also improved more in the Ubrogepant group than in the placebo group.
Further studies required
Dagny Holle-Lee, head of West German headache center at the University Hospital, which was not involved in the study, points out that the results of this exploratory analysis are less meaningful than if a controlled study specifically examined the Prodromal symptoms as a central question. “Nevertheless, the available data provide initial indications that Ubrogepant could be effective in the preliminary phase of migraines,” she says. “However, further, specifically designed studies are required in order to scientifically underpin this promising approach.”
The active ingredient Ubrogepant blocks the receptors in the brain to which the inflammatory messenger CGRP binds – one of the central culprits in migraines. So far, the drug has not been approved in Europe, but other active ingredients from the class of the panted: Atogepant and RimeGepant. Both act according to the same mechanism as Ubrogepant. So far, it has not yet been investigated whether they also have the potential to contain harbing symptoms.
Source: Peter Goadsby (King’s College London, UK) et al., Nature Medicine, DOI: 10.1038/S41591-025-03679-7