PO-35 | Treatment of chronic and episodic migraine with atogepant improves quality of life in patients with comorbid multiple sclerosis: the experience of the Headache Center at Spaziani Hospital, Frosinone

Background: Migraine is a common comorbidity in patients with Multiple Sclerosis (MS), often complicating clinical management due to overlapping symptoms, increased disability, and limited therapeutic options. Atogepant, an oral calcitonin gene-related peptide (CGRP) receptor antagonist approved for the preventive treatment of episodic migraine, has demonstrated efficacy in the general population. However, evidence regarding its use in patients with MS is currently lacking.   Methods: We present a case series involving three female patients with MS and comorbid migraine treated at the Headache Center of Spaziani Hospital. Two patients (ages 46 and 56) had Relapsing-Remitting MS (RRMS) with Episodic Migraine, and one patient (age 38) had Secondary Progressive MS (SPMS) with Chronic Migraine. All were undergoing disease-modifying therapy (DMTs): Dimethyl fumarate, Natalizumab and Siponimod. Previous prophylactic migraine treatments were either poorly tolerated or ineffective. At baseline, all patients showed moderate to severe migraine-related disability (MIDAS scores) and mild to moderate neurological impairment (EDSS). Atogepant was initiated at 60 mg once daily.   Results: After 6 months of treatment, all three patients reported a significant reduction in monthly migraine days, with substantial improvement in MIDAS scores. The patient with Chronic Migraine transitioned to an episodic migraine profile. No adverse events or worsening of MS-related symptoms were observed during treatment.   Conclusion: These preliminary observations suggest that Atogepant may be a safe and effective option for migraine prevention in patients with MS, including those receiving DMTs. The observed reduction in migraine frequency and disability, without negative impact on MS disease activity, underscores the potential of CGRP receptor antagonists in this comorbid population. Further large-scale, controlled studies are warranted to evaluate long-term safety, tolerability, and efficacy in this dual-diagnosis setting.