A Comparative Effectiveness Study of Oral Medications Used for Migraine Prevention: The APT Comparison Study
This goal of this study is to compare three medications used for migraine preventive treatment. This study will compare atogepant, a newer migraine preventive medication, with two older preventive medications, topiramate and propranolol. It will be determined if one works better and is more tolerable than the others. Research participants will: * Be randomly assigned to one of the three medications. * Provide information about their migraine pattern using a daily headache diary and during research visits.
• Adults, 18-70 years of age at the time of enrollment
• Migraine with aura, migraine without aura, and/or chronic migraine; according to ICHD-3 diagnostic criteria. (Those with daily or continuous headaches are not excluded.)
• Migraine onset prior to 50 years of age
• Migraine present for at least 12 months at the time of enrollment
• At least four moderate to severe headache days per month (by patient self-report and then confirmed during four-week pre-randomization headache diary phase) A moderate to severe headache day is defined as a day during which there is a headache of moderate to severe intensity that lasts for at least four hours, or a day on which a migraine-specific acute medication is taken to treat headache.
• If already taking a migraine preventive treatment, willing to continue with that treatment without dose change during the first 16 weeks of the study, including the 4-week run-in phase and 12-week randomized phase.
• Not pregnant or breastfeeding
• Women of childbearing potential must agree to use effective methods of contraception to reduce the risk of pregnancy.
• Willingness and ability to provide informed consent.
• Willingness and ability to complete all research visits.