Comparative Effectiveness of Migraine Preventive Medications: The APT Comparison Study

Prior treatment

• Currently taking atogepant, propranolol, or topiramate\*
• Previously took atogepant, propranolol, or topiramate\*
• Current use of a CGRP-targeting preventive medication or beta-blocker
• Migraine preventive treatment has been started or dose has been changed within 12 weeks prior to potential enrollment.
• Used opioids or butalbital on five or more days per month on average for at least 3 months prior to enrollment.

Other illness

• Secondary headache disorders (medication overuse headache is not an exclusion)
• Current or past epilepsy
• Severe hepatic impairment
• Moderate or more severe renal impairment \* Occasional as needed use of propranolol, currently or in the past, is not an exclusion, such as taking as needed propranolol for treatment of anxiety.

Other

• Contraindications to taking atogepant, propranolol, or topiramate.
• Unwillingness to take atogepant, topiramate, or propranolol.
• Migraine with brainstem aura
• Hemiplegic migraine
• Retinal migraine
• Migraine aura without headache (exclusively)
• Pure menstrual migraine
• Trigeminal autonomic cephalalgias
• Facial neuralgias

• 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.