Atogepant Reduces Psychological Dependence on Acute Treatments Evaluated With the Leeds Dependence Questionnaire: A...

The Leeds Dependence Questionnaire (LDQ) is a validated tool for assessing psychological dependence across various substances and has been adapted for use in headache patients. No study has yet explored the effects of preventive anti-CGRP treatments like atogepant on psychological dependence related to acute migraine medications.

We conducted a prospective, real-world, single-center study on patients with migraine who were treated with atogepant 60 mg daily for 12 weeks. LDQ scores were assessed at baseline and after 12 weeks. Monthly headache days (MHDs), acute medication use, and presence of psychiatric comorbidities were collected. A linear mixed-effects model evaluated the effect of treatment over time, adjusting for medication overuse (MO) status and psychiatric comorbidities.

We included 43 patients (69.8% with chronic migraine, 67.4% with MO). The LDQ total score significantly decreased from 7.95 ± 5.79 to 6.42 ± 5.08 after treatment (mean difference: -1.53, p = 0.032). Significant improvements were seen in three specific LDQ items reflecting loss of control, compulsive use, and psychological distress. No significant correlation was found between the reduction in LDQ score and the change in acute medication use. Mixed-effects modeling confirmed a significant effect of treatment (p = 0.022), but independent of MO or MOH status or psychiatric comorbidities.

Preventive treatment with atogepant is associated with a significant reduction in psychological dependence on acute migraine medications, as measured by the LDQ. These findings support the need to assess dependence-like behavior in clinical migraine care and highlight the potential behavioral benefits of effective preventive treatments.