Kingston

Researchers are evaluating the effectiveness of three medications—atogepant, topiramate, and propranolol—for preventing migraines in adults. This Phase 4 clinical trial aims to find out if one medication works better or is easier to tolerate than the others. Participants must have a history of migraine with or without aura, chronic migraine, and meet specific headache frequency and duration criteria. Participants will first track their headaches daily for four weeks. If they remain eligible, they will be randomly assigned to take one of the three study drugs—atogepant (up to 60 mg daily), propranolol (up to 80 mg twice daily), or topiramate (up to 50 mg twice daily)—for twelve weeks. The study includes several scheduled research visits at the start, at four weeks for randomization, and then at weeks four, eight, twelve, twenty-four, and forty-eight after randomization. Throughout the study, participants will use a daily headache diary and attend research visits to provide data on their migraine patterns. The main outcome measured is the proportion of participants who experience at least a 50% reduction in moderate to severe headache days during weeks 9-12 after starting the medication compared to the four weeks before medication began. Researchers will monitor treatment adherence and safety during all visits and collect data for up to 48 weeks.