Ubrogepant Combined With OnabotulinumtoxinA Effective for Breakthrough Migraine

The efficacy of ubrogepant combined with onabotulinumtoxinA to treat breakthrough migraine attacks is supported by real-world evidence presented at the 2022 American Headache Society (AHS) Annual Scientific Meeting, held from June 9-12, in Denver, Colorado, and virtually.

Ubrogepant is an oral medication that acts as an antagonist to calcitonin gene-related peptides (CGRP) which, when released in the brain, contribute to inflammation and the development of painful migraine.

Researchers conducted a prospective, observational, COURAGE study, analyzing the real-world effectiveness of ubrogepant in treating breakthrough migraine in 122 patients currently undergoing preventative treatments with onabotulinumtoxinA.

They included patients who experienced 3 or more migraine attacks in the last 30 days and who used either 50 mg or 100 mg of ubrogepant to acutely treat breakthrough migraine. Patients reported a median of 9 breakthrough migraine attacks during the 30-day period.

The researchers studied patient self-reported assessments on the Migraine Buddy application for 30 days, paying particular attention to meaningful pain relief and return to normal functioning 2 and 4 hours after ubrogepant treatment.

During the first breakthrough migraine attack, 53.3% and 76.2% of patients reported meaningful pain relief at 2 and 4 hours following ubrogepant dosing, respectively. Similarly, 25.4% and 45.9% of patients reported return to normal functioning at 2 and 4 hours after taking ubrogepant, respectively.

Cumulatively, over the first 10 breakthrough migraine attacks, meaningful pain relief  occurred in 44.8% and 72.9% of patients at 2 and 4 hours after taking ubrogepant, respectively. Additionally, 30.1% and 52.1% of patients returned to normal functioning at 2 and 4 hours following ubrogepant treatment.

“These findings support the real-world effectiveness of ubrogepant as an acute treatment in combination with onabotulinumtoxinA, providing evidence for a common treatment pattern,” the researchers concluded. “These results also demonstrate the feasibility of using a novel, app-based design to evaluate the real-world effectiveness of migraine treatment.”


Lipton RB, Engstrom E, Serrano D, et al. Real-world effectiveness of ubrogepant for the acute treatment of migraine in combination with onabotulinumtoxinA preventive: Results from the COURAGE study. Presented at: AHS 2022 Annual Scientific Meeting; June 9-12, 2022; Denver, Colorado. Poster 190.