A drug to treat debilitating migraines may start working immediately, unlike most treatments, a study published on Monday shows.
The medical research found people taking atogepant were less likely to have a migraine on the first day of treatment. They also had fewer migraines per week during each of the first four weeks of the study and fewer migraines during the study overall than those taking a placebo, the study published in Neurology found.
“With many current drugs to prevent migraine, it takes time to find the right dosage for the individual and it can take weeks or even months for it to be most effective,” said study author Dr Richard Lipton, from the Albert Einstein College of Medicine in New York.
“Some people give up and stop taking the drugs before they reach this point. Plus, many people experience side effects with current treatments. Developing a drug that works both effectively and quickly is critical.”
Researchers looked at data from three studies – called the Advance, Elevate and Progress trials – on the safety and effectiveness of atogepant over the first 12 weeks. Advance and Elevate involved patients with episodic migraine, meaning up to 14 migraine days a month, while Progress studied people with chronic migraine, or at least 15 days with headache per month.
“Migraine is the second-leading cause of disability in the overall population and the leading cause of disability in young women, with people reporting negative effects on their relationships, parenting, career and finances. Having a treatment that can act quickly and effectively addresses a key need,” Dr Lipton said.
On the first day of the Advance study, 12 per cent of those taking the drug had a migraine, compared to 25 per cent of those taking placebo. In the Elevate trial, it was 15 per cent and 26 per cent. For the third group, the numbers were 51 per cent and 61 per cent.
When researchers adjusted for other factors that could affect the rate of migraine, they found that people taking the drug were 61 per cent less likely to have a migraine in Advance, 47 per cent less likely in Elevate, and 37 per cent less likely in Progress. For the first two trials, the people taking atogepant had an average of one fewer day with migraine per week, compared to an average of less than half a day fewer per week for those taking the placebo.
For the third trial, average migraine days per week declined by about 1.5 days for those taking the drug compared to about one day for those taking the placebo. The people taking atogepant also showed improvement on assessments of how much migraine impaired their activities and their overall quality of life compared to people taking the placebo.
One limit of the study is that it involved mostly female and white participants, so the results may not apply to the overall population. The study was supported by AbbVie, the maker of atogepant.
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Three-day coronation
Royal purification
The entire coronation ceremony extends over three days from May 4-6, but Saturday is the one to watch. At the time of 10:09am the royal purification ceremony begins. Wearing a white robe, the king will enter a pavilion at the Grand Palace, where he will be doused in sacred water from five rivers and four ponds in Thailand. In the distant past water was collected from specific rivers in India, reflecting the influential blend of Hindu and Buddhist cosmology on the coronation. Hindu Brahmins and the country's most senior Buddhist monks will be present. Coronation practices can be traced back thousands of years to ancient India.
The crown
Not long after royal purification rites, the king proceeds to the Baisal Daksin Throne Hall where he receives sacred water from eight directions. Symbolically that means he has received legitimacy from all directions of the kingdom. He ascends the Bhadrapitha Throne, where in regal robes he sits under a Nine-Tiered Umbrella of State. Brahmins will hand the monarch the royal regalia, including a wooden sceptre inlaid with gold, a precious stone-encrusted sword believed to have been found in a lake in northern Cambodia, slippers, and a whisk made from yak's hair.
The Great Crown of Victory is the centrepiece. Tiered, gold and weighing 7.3 kilograms, it has a diamond from India at the top. Vajiralongkorn will personally place the crown on his own head and then issues his first royal command.
The audience
On Saturday afternoon, the newly-crowned king is set to grant a "grand audience" to members of the royal family, the privy council, the cabinet and senior officials. Two hours later the king will visit the Temple of the Emerald Buddha, the most sacred space in Thailand, which on normal days is thronged with tourists. He then symbolically moves into the Royal Residence.
The procession
The main element of Sunday's ceremonies, streets across Bangkok's historic heart have been blocked off in preparation for this moment. The king will sit on a royal palanquin carried by soldiers dressed in colourful traditional garb. A 21-gun salute will start the procession. Some 200,000 people are expected to line the seven-kilometre route around the city.
Meet the people
On the last day of the ceremony Rama X will appear on the balcony of Suddhaisavarya Prasad Hall in the Grand Palace at 4:30pm "to receive the good wishes of the people". An hour later, diplomats will be given an audience at the Grand Palace. This is the only time during the ceremony that representatives of foreign governments will greet the king.
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Day 5, Abu Dhabi Test: At a glance
Moment of the day When Dilruwan Perera dismissed Yasir Shah to end Pakistan’s limp resistance, the Sri Lankans charged around the field with the fevered delirium of a side not used to winning. Trouble was, they had not. The delivery was deemed a no ball. Sri Lanka had a nervy wait, but it was merely a stay of execution for the beleaguered hosts.
Stat of the day – 5 Pakistan have lost all 10 wickets on the fifth day of a Test five times since the start of 2016. It is an alarming departure for a side who had apparently erased regular collapses from their resume. “The only thing I can say, it’s not a mitigating excuse at all, but that’s a young batting line up, obviously trying to find their way,” said Mickey Arthur, Pakistan’s coach.
The verdict Test matches in the UAE are known for speeding up on the last two days, but this was extreme. The first two innings of this Test took 11 sessions to complete. The remaining two were done in less than four. The nature of Pakistan’s capitulation at the end showed just how difficult the transition is going to be in the post Misbah-ul-Haq era.
