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Head-to-Head: which migraine pill works best?

NCT ID NCT06972056

Disease control Sponsor: Mayo Clinic Source: ClinicalTrials.gov ↗

What the study statuses mean

This study's is highlighted.

Recruitment status, easiest to join first

Recruiting now This study
This trial is taking on new participants right now.
Not yet recruiting
Registered, but not yet taking participants.
By invitation only
Not open to general applications. Only people the study team invites can take part.
Paused
Paused for now. It may or may not start again.
Ongoing
Running, but no longer taking on new participants.
Completed
The trial has finished. Results may not be published yet.
Stopped early
Stopped early, before it reached the end. That can be for many reasons, including safety.
Cancelled
Cancelled before anyone took part.

Expanded access (not trials)

Expanded access
Not a trial. This treatment can be requested outside a study, case by case, for people who qualify.
Expanded access (paused)
Not a trial. The treatment can normally be requested outside a study, but is unavailable right now.
Expanded access (ended)
Not a trial. The treatment could once be requested outside a study, but no longer can.
Approved
The treatment has been approved, so it is available normally rather than through this programme.

When the status isn't known

Details not published
The full record has not been published yet, so there is little to show here.
Status unknown
This status has not been confirmed recently, so it may be out of date.

First seen Jun 25, 2026 · Last updated Sep 17, 2026 · Updated 7 times

Summary

This study compares three oral medications used to prevent migraines: atogepant (a newer drug), topiramate, and propranolol (both older). About 1,335 adults with migraine will be randomly assigned to one of the three drugs for 12 weeks. Researchers will track headache frequency and how long people stay on their assigned medication to see which option works best and is most tolerable.

What this could mean

Our plain-language read of the trial. This is informational only, not medical advice or a prediction.

Active substance
atogepant, propranolol, topiramate
What this could lead to
If successful, this could help doctors choose the most effective and tolerable migraine prevention medication for patients.
What could go wrong
This is a comparative effectiveness study, not a test for a new cure. Results may show no clear winner, and individual responses vary. Side effects are possible with each drug.

This is an AI summary of the original study and may miss details. Read our disclaimer.

Study facts

What this study's own registry entry says, in plain language.

Phase

Phase 4

Runs after approval, following long-term safety and how well the treatment works in everyday use.

Participants

About 1,335 people

The number the study aims to enrol. It can still change while the study runs.

Started

Jul 2025

Expected to finish

Dec 2029

An estimate. End dates often move.

Lead sponsor

Other sponsor

The registry's catch-all category, for sponsors it does not file as a company, a government agency, or a research network.

Who can take part

This study's own entry requirements. Only the study team can say for certain whether you qualify.

Ages

18 to 70 years

Sex

Anyone

Healthy volunteers

Not accepted

This study is not open to healthy volunteers. The entry requirements below say who it is open to.

Show the full entry requirements

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * Adults, 18-70 years of age at the time of enrollment * Migraine with aura, migraine without aura, and/or chronic migraine; according to ICHD-3 diagnostic criteria. (Those with daily or continuous headaches are not excluded.) * Migraine onset prior to 50 years of age * Migraine present for at least 12 months at the time of enrollment * At least four "moderate to severe headache days" per month (by patient self-report and then confirmed during four-week pre-randomization headache diary phase) A "moderate to severe headache day" is defined as a day during which there is a headache of moderate to severe intensity that lasts for at least four hours, or a day on which a migraine-specific acute medication is taken to treat headache. * If already taking a migraine preventive treatment, willing to continue with that treatment without dose change during the first 16 weeks of the study, including the 4-week run-in phase and 12-week randomized phase. * Not pregnant or breastfeeding * Women of childbearing potential must agree to use effective methods of contraception to reduce the risk of pregnancy. * Willingness and ability to provide informed consent. * Willingness and ability to complete all research visits. Exclusion Criteria: * Contraindications to taking atogepant, propranolol, or topiramate. * Currently taking atogepant, propranolol, or topiramate\* * Previously took atogepant, propranolol, or topiramate\* * Unwillingness to take atogepant, topiramate, or propranolol. * Current use of a CGRP-targeting preventive medication or beta-blocker * Migraine with brainstem aura * Hemiplegic migraine * Retinal migraine * Migraine aura without headache (exclusively) * Pure menstrual migraine * Trigeminal autonomic cephalalgias * Facial neuralgias * Secondary headache disorders (medication overuse headache is not an exclusion) * Migraine preventive treatment has been started or dose has been changed within 12 weeks prior to potential enrollment. * Used opioids or butalbital on five or more days per month on average for at least 3 months prior to enrollment. * Current or past epilepsy * Severe hepatic impairment * Moderate or more severe renal impairment \* Occasional as needed use of propranolol, currently or in the past, is not an exclusion, such as taking as needed propranolol for treatment of anxiety.

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Conditions

The condition(s) this trial relates to.

migraine disorder migraine with aura migraine without aura

As listed by the trial registrant

The condition terms exactly as the trial's registrant entered them.

Migraine

How to take part

Only the study team decides who joins. These are the ways to reach them.

  1. The study's own enquiry address

    This study publishes an address for enquiries. See it below .

  2. The places running it

    36 sites. The list below names each one and where it is.

  3. The official record

    ClinicalTrials.gov lists the study team's own contact details, including names and phone numbers. We don't republish those.

    Open the record ↗

  4. A doctor treating you

    A doctor who knows your case can contact a study site on your behalf, and can tell you whether this study is worth pursuing at all.

Contacts and locations

Study contacts

  • Contact

    Email: •••••@•••••

Locations

  • Advanced Research Institute

    RECRUITING

    Portland, Oregon, 97223, United States

  • Advanced Research Institute Ogden

    RECRUITING

    Ogden, Utah, 84405, United States

  • Advanced Research Institute Reno

    RECRUITING

    Reno, Nevada, 89511, United States

  • Apple Med Research

    RECRUITING

    Miami, Florida, 33126, United States

  • Brown University Health

    RECRUITING

    Providence, Rhode Island, 02903, United States

  • Clinical Research Institute

    RECRUITING

    Los Angeles, California, 90048, United States

  • Clinical Trials of New England

    RECRUITING

    Hyde Park, Massachusetts, 02136, United States

  • DHR Health Headache Center

    RECRUITING

    McAllen, Texas, 78504, United States

  • Desert Physicians Medical Group

    RECRUITING

    Palm Springs, California, 92262, United States

  • JFK Neuroscience Institute

    RECRUITING

    Edison, New Jersey, 08820, United States

  • Keck School of Medicine of USC

    RECRUITING

    Los Angeles, California, 90033, United States

  • Marshfield Clinic Research Institute

    RECRUITING

    Marshfield, Wisconsin, 54449, United States

  • Mayo Clinic

    RECRUITING

    Rochester, Minnesota, 55905, United States

  • Mayo Clinic Arizona

    RECRUITING

    Phoenix, Arizona, 85054, United States

  • Mayo Clinic Florida

    RECRUITING

    Jacksonville, Florida, 32066, United States

  • Memorial Healthcare

    RECRUITING

    Hollywood, Florida, 33021, United States

  • Mt Sinai Icahn School of Medicine

    RECRUITING

    New York, New York, 10029, United States

  • Nebraska Medical Center

    RECRUITING

    Omaha, Nebraska, 68198, United States

  • Neuroscience Research Center

    RECRUITING

    Overland Park, Kansas, 66210, United States

  • Northern Arizona Healthcare

    RECRUITING

    Flagstaff, Arizona, 86001, United States

  • Northwell Health

    RECRUITING

    Manhasset, New York, 11030, United States

  • Nuvance Health Institute

    RECRUITING

    Kingston, New York, 12401, United States

  • Ohio State University Wexner Medical Center

    RECRUITING

    Columbus, Ohio, 43210, United States

  • Onsite Clinical Solutions Ballantyne

    RECRUITING

    Charlotte, North Carolina, 28277, United States

  • Onsite Clinical Solutions Mecklenburg

    RECRUITING

    Charlotte, North Carolina, 28211, United States

  • Onsite Clinical Solutions Park Cedar Dr.

    RECRUITING

    Charlotte, North Carolina, 28210, United States

  • Onsite Clinical Solutions Salisbury

    RECRUITING

    Salisbury, North Carolina, 28144, United States

  • The Medical College of Wisconsin

    RECRUITING

    Milwaukee, Wisconsin, 53226, United States

  • The Neurology Group

    RECRUITING

    Pomona, California, 91767, United States

  • University of Colorado Anschutz Medical Campus

    RECRUITING

    Aurora, Colorado, 80045, United States

  • University of Miami

    RECRUITING

    Miami, Florida, 33136, United States

  • University of Pennsylvania

    RECRUITING

    Philadelphia, Pennsylvania, 19107, United States

  • Vanderbilt Medical Center

    RECRUITING

    Nashville, Tennessee, 37215, United States

  • Wake Forest University Health

    RECRUITING

    Winston-Salem, North Carolina, 27157, United States

  • Washington University St Louis

    RECRUITING

    St Louis, Missouri, 63110, United States

  • West Virginia University

    RECRUITING

    Morgantown, West Virginia, 26506, United States

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