King's College London

The research, published in Nature Medicine, offers hope to people managing a collection of symptoms that research has typically overlooked.

Migraine sufferers typically experience a range of non-headache related symptoms in the period leading up to a migraine. These early-onset symptoms – known as premonitory (prodromal) symptoms – include a sensitivity to light and sound, nausea, neck pain, brain fog and dizziness. Despite the commonality of these indicators, very little research has looked their management and no treatment has been shown to alleviate them.

In this double-blind Phase III trial, 438 participants aged 18-75 with at least a one-year history of experiencing migraine were randomly assigned into one of two groups. Each participant was instructed to take either a 100mg dose of ubrogepant or placebo when their premonitory (prodromal symptoms) first occurred and felt confident that a migraine headache would take place within one to six hours. They were then asked to repeat this process using the opposite treatment at least 7 days later; the order of treatment was randomized.

When participants used ubrogepant, they self-reported reductions in the severity of all of their premonitory (prodromal) symptoms in the 24-hour period following their treatment compared to placebo.

Professor Peter Goadsby, Director of the NIHR King’s Clinical Research Facility and Lead of Pain and Addictions theme at the NIHR Maudsley Biomedical Research Centre, Professor of Neurology and the study’s first author from King’s IoPPN said, “Migraine is a highly debilitating condition that can have a dramatic impact on a person’s day to day life. Migraine is almost always preceded by a group of symptoms that can feel as difficult to manage as the headache itself.

“Our study has found that a drug that’s already used to treat a migraine headache is also an effective means of reducing the severity of these early-onset symptoms.”

This research was funded and partially designed by AbbVie.

 

Ubrogepant for the treatment of migraine prodromal symptoms: an exploratory analysis from the randomized phase 3 PRODROME trial (Peter J. Goadsby, Jessica Ailani, David W. Dodick, Amaal J. Starling, Chengcheng Liu, Yingyi Liu, Sung Yun Yu, Jonathan H. Smith, Elimor Brand-Schieber & Joel M. Trugman) (DOI10.1038/s41591-025-03679-7) was published in Nature Medicine.

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