Effectiveness of atogepant in migraine with and without medication overuse: Pooled real-world analysis of two independent clinical cohorts.

BACKGROUND: Medication-overuse headache (MOH) is common in treatment-resistant chronic migraine and may complicate preventive management. The aim of this study was to evaluate the short-term effectiveness of atogepant 60 mg once daily in a pooled real-world population of patients with migraine, including treatment-resistant chronic migraine, and to explore whether baseline MOH influenced treatment response. METHODS: This pooled observational study combined two independent real-world cohorts of patients treated with atogepant 60 mg once daily for migraine prevention. The database included 78 patients, with short-term follow-up recorded at 12 weeks in one cohort and at 3 months in the other. Monthly migraine days (MMD), monthly symptomatic medication use, Migraine Disability Assessment (MIDAS), Headache Impact Test-6 (HIT-6), and treatment documentation were harmonized. Effectiveness was analyzed in the pooled population, while exploratory comparisons were performed according to baseline medication-overuse headache (MOH) status. RESULTS: The pooled database included 78 patients, and paired MMD measurements were available for 73. Median MMD decreased from 13.0 [10.0-20.0] to 4.0 [3.0-8.0], with a median reduction of 7.0 [6.0-11.0] days/month (p < 0.001). A reduction of at least 50% was achieved by 54/73 patients (74.0%). MIDAS, HIT-6, and monthly symptomatic medication use also improved significantly (all p < 0.001). MOH status was available for 77 patients: 24 had MOH and 53 did not. Patients with MOH had a greater baseline burden and larger absolute reductions in MMD and symptomatic medication use; however, MMD percentage reduction and responder rates did not differ significantly by MOH status. Adverse-event documentation was available for 70 patients, of whom 19 had at least one recorded event. CONCLUSIONS: In this pooled real-world analysis, atogepant was associated with clinically meaningful short-term improvement in migraine frequency, disability, headache impact, and symptomatic medication use. Baseline MOH was associated with greater initial disease burden but did not appear to attenuate proportional treatment response. Because safety and persistence were documented differently in the two cohorts, pooled tolerability estimates should be interpreted descriptively.