Can atogepant be a preventive treatment for cluster headache?-Insights from a case series

[Craigo]

Can atogepant be a preventive treatment for cluster headache?-Insights from a case series
Catarina Serrão, Filipa Dourado Sotero, Linda Azevedo Kaupilla, Isabel Pavão Martins

Published in Headache on October 3, 2025
Link: https://doi.org/10.1111/head.15066

Abstract:
Cluster headache (CH) is a disabling primary headache disorder with limited therapeutic options. Calcitonin gene-related peptide (CGRP) is known to be involved in CH pathophysiology; however, except for galcanezumab (300 mg) in episodic CH, anti-CGRP monoclonal antibodies did not reduce CH attacks in randomized clinical trials. Atogepant is an oral, small-molecule, CGRP receptor antagonist, which is approved for the preventive treatment of migraine. Here, we describe four case reports of CH (two episodic CH and two chronic CH), unresponsive to previous prophylactic treatments, who responded to daily atogepant (60 mg). Chronic CH cases were refractory to subcutaneous galcanezumab. In one case, a reduction to atogepant (30 mg daily) resulted in recurrence of headache attacks, which subsided on reintroduction of the initial dose. No serious adverse effects were reported. Despite the limited number of cases and the open retrospective design, our case series suggests atogepant as a possible prophylactic treatment for CH. Further research on CGRP signaling in CH and the implementation of well-designed clinical trials are necessary.

[CHfather]

In the US, the brand name for atogepant is Qulipta. In the EU, I think it's Aquipta.

@Craigo, thank you for this (and for all your other great contributions to substantive knowledge about CH)!  I notice that Ubrelvy and Nurtec are both also gepant formulations.  Might we imagine that they would also help (it seems from the abstract that the contrast in this study is with galcanezumab (Emgality))?