When atogepant, one of the newest preventive treatments for migraine, arrived in hospitals in 2024, clinical trials had already demonstrated its effectiveness in preventing migraine. What was still unknown was whether it would also work in people who had already exhausted all other available preventive options. Now, a study led by Hospital de Bellvitge and the Bellvitge Biomedical Research Institute (IDIBELL) provides the first answer: yes, a proportion of these patients also benefit.
Migraine is one of the leading causes of disability worldwide and affects nearly 900,000 people in Catalonia. Despite advances in recent years, there are people who, despite having tried all available preventive treatments, continue to suffer migraines almost every day. This study offers a new option precisely for this group of people.
The results, published in The Journal of Headache and Pain, show that around 30% of patients with the most refractory migraine halve their migraine days after three months of treatment.
Coordinated from the Headache Unit at Bellvitge Hospital, the study involved 17 hospitals from across the country. It is the first multicentre study to evaluate the effectiveness of this treatment in people who had no longer responded to monoclonal antibodies targeting CGRP, one of the main preventive options available.
A new alternative for the most difficult cases to treat
The study included 252 people with highly complex clinical migraine. More than 80% had chronic migraine, almost half suffered from daily headaches, and all had failed on previous preventive treatments, including anti-CGRP monoclonal antibodies.
Despite this particularly complex profile, the results show that nearly 30% of patients reduce their migraine days by at least 50%; 44% experience a significant clinical improvement; and both pain intensity and the need for medication to treat attacks decrease.
"When this treatment came along, we were all asking the same question: would it also work when other drugs had already failed? This study is the first to allow us to answer that question," explains Dr Albert Muñoz-Vendrell, a neurologist at Hospital de Bellvitge, a clinical researcher in the IDIBELL's Neurological Diseases and Neurogenetics group, and the study's principal investigator.
Evidence in real-world clinical practice
Unlike clinical trials, this study reflects what happens in routine healthcare practice, with patients who have years of disease progression and multiple treatment failures.
The analysis also shows that the more preventive treatments that have previously failed, the lower the probability of a response, a finding that can help to better guide therapeutic decisions and reinforces the importance of a personalised approach.
This study reinforces the role of Bellvitge Hospital as a centre of excellence in migraine research and is part of a line of research aimed at generating evidence in real-world clinical practice to improve patient management. In the same vein, a study by the same team, published in Headache, suggests that current criteria may underestimate the benefits of biological treatments, as they do not always reflect improvements in quality of life.
Migraine is much more than a headache
Migraine is one of the leading causes of disability worldwide. In the State, it is estimated to affect nearly 12% of the population. In Catalonia, it is estimated that around 900,000 people live with this condition. This impact reinforces the need to move towards more personalised models that allow a better assessment of the real benefits of treatments.
Bellvitge Hospital also promotes outreach initiatives such as the ‘Veus de Bellvitge’ podcast, with Dr Albert Muñoz-Vendrell, which addresses migraine from a clinical and experiential perspective.
Bibliographic reference
Muñoz-Vendrell, A., Campoy-Díaz, S., Valín-Villanueva, P. et al. Atogepant after anti-CGRP monoclonal antibodies failure in migraine: a multicenter real-world study of effectiveness, safety, persistence and predictors of response. J Headache Pain 27, 2 (2026). DOI: 10.1186/s10194-025-02239-1