DOI: 10.1177/03331024261495542 ISSN: 0333-1024

Atogepant for preventive treatment of episodic cluster headache: A single-center case series of 18 patients

Yooha Hong, Mi-Kyoung Kang, Soo-Jin Cho
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Background

Cluster headache (CH) is a highly disabling primary headache disorder characterized by severe unilateral attacks occurring in bouts. Calcitonin gene-related peptide plays a key role in CH pathophysiology, yet preventive treatment options remain limited. We aimed to evaluate the short-term clinical effects of atogepant in patients with episodic CH during an active cluster bout.

Methods

We conducted a single-center real-world observational study. The study protocol included both retrospective and prospective cohorts, but all patients in the present analysis were from the retrospective cohort. Adult patients with episodic CH treated with atogepant during an active bout were consecutively included. Weekly headache outcomes during baseline (the week prior to treatment) and week 1 after atogepant initiation were compared. The primary outcome was change in weekly headache days; secondary outcomes included attack frequency, pain intensity, attack duration, and acute medication use. Responder rates (≥ 50% reduction) and Patient Global Impression of Change (PGIC) were assessed.

Results

Eighteen patients were included (mean age 39.9 ± 11.2 years; 72.2% male). Significant improvements were observed across all outcomes within one week after atogepant initiation. Weekly headache days decreased from 7.0 (5.0–7.0) to 3.0 (2.0–7.0) ( p  = 0.008), and attack frequency from 7.5 (5.5–14.0) to 3.0 (2.0–7.0) ( p  = 0.018). Pain intensity, attack duration, and acute medication use were also reduced. Large effect sizes were observed (r = 0.56–0.79). A ≥ 50% reduction in headache days occurred in 50.0% of patients and in attack frequency in 81.2%. PGIC ratings indicated that 66.7% of patients were rated as much or very much improved.

Discussion

In this open-label, uncontrolled study, atogepant initiation was associated with short-term improvements across multiple headache outcomes within one week in patients with episodic CH. Given the small sample size, retrospective data collection, short follow-up, and concurrent preventive therapies, these preliminary findings require confirmation in randomized, placebo-controlled trials.

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