PO-76 | Atogepant reduces psychological dependence to acute treatments evaluated with the Leeds dependence questionnaire (LDQ): a prospective observational study

Luigi Francesco Iannone,^1,2 Marina Romozzi,^3,4 Alberto Boccalini,¹ Flavia Lo Castro,¹ Claudia Altamura,⁵ Fabrizio Vernieri,⁵ Simona Guerzoni¹ | ¹Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse-Laboratory of Clinical Pharmacology and Pharmacogenomics, AOU Policlinico di Modena, Modena, Italy; ²Department of Biomedical, Metabolic, and Neural Science, University of Modena and Reggio Emilia, Modena, Italy; ³Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy; ⁴Neurologia, Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; ⁵Headache Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy; 6Università Campus Bio-Medico di Roma, Italy

Background: Migraine management often leads to acute medication misuse and overuse, a major contributor to migraine burden, and dependence-like behaviors. 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 studies have yet explored the effects of preventive anti-CGRP treatments like atogepant on psychological dependence related to acute migraine medications.

Methods: We conducted a prospective, real-world, single-center study enrolling 43 migraine patients (69.8% with chronic migraine, 67.4% with MO), treated with atogepant 60 mg daily for 12 weeks. LDQ scores were assessed at baseline and after 12 weeks. Additional clinical variables, including monthly headache days (MHDs), acute medication use, and presence of psychiatric comorbidities, were recorded. A linear mixed-effects model evaluated the effect of treatment over time, adjusting for MO status and psychiatric comorbidities.

Results: 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 LDQ score reduction and change in acute medication use. Mixed-effects modelling confirmed a significant effect of treatment (p = 0.022), but independent of MO or MOH status or psychiatric comorbidities.

Conclusion: 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 integration of dependence assessment in clinical migraine care and highlight the potential behavioral benefits of effective preventive treatments.