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Kaimen Rigor review

Ubrogepant for the treatment of migraine prodromal symptoms: an exploratory analysis from the randomized phase 3 PRODROME trial.

Goadsby PJ, Ailani J, Dodick DW, Starling AJ, Liu C, Liu Y, Yu SY, Smith JH, Brand-Schieber E, Trugman JM

DOI: 10.1038/s41591-025-03679-7
Record issued: 2026-08-15
Engine: 7.39.0
Exported: 2026-09-22

Prepared by Alpha1. This document is confidential: it is intended for the recipient it was shared with and must not be redistributed. The live record at alpha1science.com/verify/f7c66cf8-4151-4407-ac44-5af95d63bcf6 is authoritative.

Kaimen Rigor review

Kaimen Rigor reviewed

2.75 / 5

Weak — serious problems found

Interventional Study

Critical

High-priority

How this rating was calculated

Started at 5★ — deductions

IntegrityIntegrity concern ×2−1★
ClaimsEfficacy rests on an unvalidated surrogate endpoint−0.5★
ClaimsTreatment effect not shown to be clinically meaningful−0.5★
ReportingData & code availability partially met−0.25★

Model-reported confidence: highReviewer agreement: highEngine: 7.39.0Source: full text

Not verified in this report

The numeric-impossibility checks (GRIM/GRIMMER/DEBIT/SPRITE) did not run: 3 reported means were read, and their group size is not stated where the values are printed (this source has no machine-readable table structure). These checks need the count the mean was averaged over, so none was performed.

Biggest issues

01Efficacy rests on an unvalidated surrogate endpoint
highOverreachreviewer-assessedFull detail
The primary efficacy claim is based on resolution of prodromal symptoms (photophobia, fatigue, neck pain, phonophobia, dizziness, difficulty concentrating, difficulty thinking), which are patient-reported symptoms, not hard clinical outcomes. These are surrogate endpoints for the clinical benefit of treating migraine prodrome. The paper does not provide evidence of target engagement at the tested dose (e.g., PK/PD) nor does it cite validated evidence linking resolution of these prodromal symptoms to long-term clinical outcomes such as prevention of headache or improved quality of life. The primary endpoint of the trial (absence of moderate/severe headache) is mentioned but the analysis here focuses on symptom resolution, which is a surrogate.
“Treatment with ubrogepant during the prodromal phase may ameliorate common prodromal symptoms, with improvements possibly as early as 1 h post-dose.”
Find in source
02Treatment effect not shown to be clinically meaningful
highOverreachreviewer-assessedFull detail
The reported effects are small absolute differences between ubrogepant and placebo for symptom absence (e.g., photophobia 19.5% vs 12.5%, fatigue 27.3% vs 16.8%, neck pain 28.9% vs 15.9%, phonophobia 50.7% vs 35.8%, dizziness 88.5% vs 82.3%, difficulty concentrating 8.7% vs 2.1%, difficulty thinking 56.9% vs 41.8%). These are modest absolute improvements and the paper does not anchor them to a minimal clinically important difference or demonstrate that they translate into meaningful patient benefit. The odds ratios are statistically significant but the clinical meaningfulness is not established.
“at 2 h post-dose, absence of photophobia in 19.5% and 12.5% of ubrogepant- and placebo-treated events, respectively (odds ratio (OR) = 1.72 (95% confidence interval (CI) = 1.13–2.61))”
Find in source

Findings by category

101ArithmeticNumerical inconsistencies 302OverreachOverstated conclusions 03AuthenticityNone found 104DisclosureReporting gaps 05AvailabilityNone found 06Copyedit3 minor suggestions

This Kaimen Rigor review uses Kaimen Rigor reviewers trained on a curated corpus of high-fidelity and retracted papers, with expert supervision and curation. It can still make mistakes; verify each finding against the source before relying on it.

This is a well-conducted phase 3 randomized crossover trial with rigorous design, clear reporting of demographics, ethics approvals, and statistical methods. The paper is transparent about limitations and provides a concrete data-sharing route. Minor copyedit issues and a few reporting gaps (e.g., CONSORT checklist, exact p-values) do not undermine the overall integrity.

Both reviewers classified the study as interventional, and I adopted that. The evaluation covered all eight dimensions; several sub-criteria were not applicable (e.g., animal-related items, code sharing). The reviewers diverged slightly on data code availability (warn vs pass) and reporting guideline (not reported vs reported and adequate), but the combined evidence supports pass. The statistics verification covered only 7 tests with test statistics or CIs; other reported statistics were not machine-verified.

Numerical inconsistencies

1 finding · worst low

Values that contradict each other or are impossible for the stated sample: recomputed p-values and test statistics, GRIM/GRIMMER checks on summary numbers, percentages against their own counts, totals against their parts, and estimates against their own confidence intervals.

Internal contradictions in the reported numbersAssessed

Recomputed 7 tests: 7 consistent, 0 inconsistent; 7 via agent-written checks.

Agent-written checks— recomputed from reported CIs / ratios by code the agent wrote

CONSISTENTreported p = .011 · recomputed p = .011Reviewer 2
Recompute p-value for photophobia absence at 2h from OR and 95% CI.
“at 2 h post-dose, absence of photophobia in 19.5% and 12.5% of ubrogepant- and placebo-treated events, respectively (odds ratio (OR) = 1.72 (95% confidence interval (CI) = 1.13–2.61))”
Find in source
Taken as given: The OR is 1.72 with 95% CI 1.13-2.61.; The CI is two-sided at 95%.; The OR is on a log scale for the pCI function.
Method: Used pCI function to derive two-sided p-value from OR and CI.
How we recomputed it: pCI(1.72, 1.13, 2.61, 1)
CONSISTENTreported p = .008 · recomputed p = .008Reviewer 2
Recompute p-value for fatigue absence at 3h from OR and 95% CI.
“at 3 h post-dose, absence of fatigue occurred in 27.3% and 16.8% (OR = 1.85 (95% CI = 1.17–2.92))”
Find in source
Taken as given: The OR is 1.85 with 95% CI 1.17-2.92.; The CI is two-sided at 95%.; The OR is on a log scale for the pCI function.
Method: Used pCI function to derive two-sided p-value from OR and CI.
How we recomputed it: pCI(1.85, 1.17, 2.92, 1)
CONSISTENTreported p = .005 · recomputed p = .004Reviewer 2
Recompute p-value for neck pain absence at 3h from OR and 95% CI.
“absence of neck pain in 28.9% and 15.9% (OR = 2.04 (95% CI = 1.25–3.32))”
Find in source
Taken as given: The OR is 2.04 with 95% CI 1.25-3.32.; The CI is two-sided at 95%.; The OR is on a log scale for the pCI function.
Method: Used pCI function to derive two-sided p-value from OR and CI.
How we recomputed it: pCI(2.04, 1.25, 3.32, 1)
CONSISTENTreported p < .001 · recomputed p = <.001Reviewer 2
Recompute p-value for phonophobia absence at 4h from OR and 95% CI.
“at 4 h post-dose, absence of phonophobia in 50.7% and 35.8% (OR = 1.97 (95% CI = 1.38–2.80))”
Find in source
Taken as given: The OR is 1.97 with 95% CI 1.38-2.80.; The CI is two-sided at 95%.; The OR is on a log scale for the pCI function.
Method: Used pCI function to derive two-sided p-value from OR and CI.
How we recomputed it: pCI(1.97, 1.38, 2.80, 1)
CONSISTENTreported p = .049 · recomputed p = .049Reviewer 2
Recompute p-value for dizziness absence at 24h from OR and 95% CI.
“at 24 h post-dose, absence of dizziness in 88.5% and 82.3% (OR = 1.82 (95% CI = 1.00–3.30))”
Find in source
Taken as given: The OR is 1.82 with 95% CI 1.00-3.30.; The CI is two-sided at 95%.; The OR is on a log scale for the pCI function.
Method: Used pCI function to derive two-sided p-value from OR and CI.
How we recomputed it: pCI(1.82, 1.00, 3.30, 1)
CONSISTENTreported p = .028 · recomputed p = .028Reviewer 2
Recompute p-value for difficulty concentrating absence at 1h from OR and 95% CI.
“as early as 1 h post-dose for difficulty concentrating in 8.7% and 2.1% of ubrogepant- and placebo-treated events, respectively (OR = 4.26 (95% CI = 1.17–15.54))”
Find in source
Taken as given: The OR is 4.26 with 95% CI 1.17-15.54.; The CI is two-sided at 95%.; The OR is on a log scale for the pCI function.
Method: Used pCI function to derive two-sided p-value from OR and CI.
How we recomputed it: pCI(4.26, 1.17, 15.54, 1)
CONSISTENTreported p = .017 · recomputed p = .017Reviewer 2
Recompute p-value for difficulty thinking absence at 6h from OR and 95% CI.
“at 6 h for difficulty thinking in 56.9% and 41.8% (OR = 2.05 (95% CI = 1.14–3.71))”
Find in source
Taken as given: The OR is 2.05 with 95% CI 1.14-3.71.; The CI is two-sided at 95%.; The OR is on a log scale for the pCI function.
Method: Used pCI function to derive two-sided p-value from OR and CI.
How we recomputed it: pCI(2.05, 1.14, 3.71, 1)

lowinternal contradiction
The abstract states 'Of 1,087 screened participants, 477 formed the efficacy analysis population.' The results section states 'A total of 1,087 participants were screened, with 518 randomly assigned to double-blind crossover treatment (Fig. ). The safety and modified intention-to-treat (mITT) populations included 480 and 477 participants, respectively.' This is consistent.
Of 1,087 screened participants, 477 formed the efficacy analysis population. ... The safety and modified intention-to-treat (mITT) populations included 480 and 477 participants, respectively.
Abstractreviewer’s wording
lowinternal contradiction
In Table 1, the 'Total' column for race sums to 480 (423+37+11+2+6+1=480), but the 'Missing' row shows 1, which would make the sum 481. However, the footnote says 'Participants who reported multiple races are included only in the ‘multiple’ category.' This may be a rounding issue or a typo.
“White | 214 (86.6) | 209 (89.7) | 423 (88.1) | | Black or African American | 22 (8.9) | 15 (6.4) | 37 (7.7) | | Asian | 7 (2.8) | 4 (1.7) | 11 (2.3) | | Native Hawaiian or other Pacific Islander | 1 (0.4) | 1 (0.4) | 2 (0.4) | | Multiple a | 2 (0.8) | 4 (1.7) | 6 (1.3) | | Missing | 1 (0.4) | 0 | 1 (0.2) |”
Table 1Find in source

Overstated conclusions

3 findings · worst high

Conclusions that reach past what the paper's own results support — including a significance claim that no longer holds when the statistic is recomputed, and efficacy resting on an unvalidated surrogate endpoint.

Efficacy rests on an unvalidated surrogate endpointAssessed
Treatment effect not shown to be clinically meaningfulAssessed
Conclusions only partially backed by the presented evidenceAssessed

3 major claims checked against the paper's own evidence: 1 only partially supported (evidence backs part of the claim; gaps or caveats remain); the rest adequately supported.

partialReviewer 2
The findings support a central nervous system origin for migraine attacks.
The claim is partially supported by the observed effects on cognitive symptoms, but the paper acknowledges that peripheral mechanisms could also explain some effects.
Evidence: Discussion of brain imaging and the observed resolution of cognitive symptoms.
“The new data firmly support a brain origin for migraine attacks.”
DiscussionFind in source
supportedReviewer 2
Ubrogepant administered during the prodromal phase may ameliorate common prodromal symptoms.
The claim is supported by the reported ORs and CIs showing statistically significant improvements for several symptoms.
Evidence: ORs with 95% CIs for photophobia, fatigue, neck pain, phonophobia, dizziness, difficulty concentrating, and difficulty thinking.
“Treatment with ubrogepant during the prodromal phase may ameliorate common prodromal symptoms, with improvements possibly as early as 1 h post-dose.”
AbstractFind in source
supportedReviewer 2
Ubrogepant may treat symptoms such as photophobia, phonophobia and cognitive dysfunction.
The claim is supported by the reported ORs and CIs for these symptoms.
Evidence: ORs and CIs for photophobia, phonophobia, difficulty concentrating, and difficulty thinking.
“ubrogepant 100 mg, when administered in the premonitory (prodromal) phase of migraine, before a headache has commenced, may treat symptoms such as photophobia, phonophobia and cognitive dysfunction.”
ConclusionFind in source

Premise concern: surrogate not validated for clinical benefit; effect size not shown to be clinically meaningful.

INADEQUATESurrogate endpoint
The primary efficacy claim is based on resolution of prodromal symptoms (photophobia, fatigue, neck pain, phonophobia, dizziness, difficulty concentrating, difficulty thinking), which are patient-reported symptoms, not hard clinical outcomes. These are surrogate endpoints for the clinical benefit of treating migraine prodrome. The paper does not provide evidence of target engagement at the tested dose (e.g., PK/PD) nor does it cite validated evidence linking resolution of these prodromal symptoms to long-term clinical outcomes such as prevention of headache or improved quality of life. The primary endpoint of the trial (absence of moderate/severe headache) is mentioned but the analysis here focuses on symptom resolution, which is a surrogate.
“Treatment with ubrogepant during the prodromal phase may ameliorate common prodromal symptoms, with improvements possibly as early as 1 h post-dose.”
Find in source
INADEQUATEEffect size
The reported effects are small absolute differences between ubrogepant and placebo for symptom absence (e.g., photophobia 19.5% vs 12.5%, fatigue 27.3% vs 16.8%, neck pain 28.9% vs 15.9%, phonophobia 50.7% vs 35.8%, dizziness 88.5% vs 82.3%, difficulty concentrating 8.7% vs 2.1%, difficulty thinking 56.9% vs 41.8%). These are modest absolute improvements and the paper does not anchor them to a minimal clinically important difference or demonstrate that they translate into meaningful patient benefit. The odds ratios are statistically significant but the clinical meaningfulness is not established.
“at 2 h post-dose, absence of photophobia in 19.5% and 12.5% of ubrogepant- and placebo-treated events, respectively (odds ratio (OR) = 1.72 (95% confidence interval (CI) = 1.13–2.61))”
Find in source

Data authenticity concerns

None found

An adversarial read for patterns associated with data that may not be genuine: results that look too clean, implausibly large effects, duplicated data or images, and methods that do not match the results reported.

Checked — nothing surfaced.

Reporting gaps

1 finding · worst medium

Required detail the manuscript never states — study design, biological variables, ethics approval and consent, key resources, statistical reporting, data and code availability, and overall transparency.

Data/code availability incompleteAssessed

Eight Dimensions7 pass · 1 warn

The introduction cites prior work on the premonitory phase (refs 8-13), the role of CGRP (ref 21), and prior gepant trials in the prodrome (refs 20, 22, 23). It also cites functional imaging and neurobiology supporting a central nervous system origin (refs 14-16, 32-35). The rationale linking prodromal symptoms to a brain site of action for gepants is argued in the Discussion.

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedINADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

The paper establishes a clear scientific premise: migraine has a premonitory phase with characteristic symptoms, and CGRP receptor antagonists (gepants) may act centrally. Prior work on the prodrome and on gepants is cited.

Evidence

paraphrase[Introduction, paragraphs 1-3; References 8-23]

“The attack has recognized phases: premonitory (prodrome), aura, headache and postdrome... The identification of the role of calcitonin gene-related peptide (CGRP), and the utility of CGRP blockers for both acute and preventive treatment of migraine offer the possibility of exploring migraine pathophysiology with new tools.”

paraphrase[Discussion, paragraphs 2-4]

“Paraphrase: The paper argues that cognitive prodromal symptoms (difficulty concentrating/thinking) point to a brain site of action, whereas photophobia/phonophobia could be peripheral. Imaging and neurobiology studies are cited to support a central origin.”

PASSReviewer 2· 90% conf

The paper establishes a strong scientific premise with extensive prior work and a clear rationale linking prodromal symptoms to central nervous system mechanisms.

Evidence

“Migraine is a common, globally recognized , neurological disorder characterized by recurrent disabling attacks involving headache and symptoms of brain dysfunction .”

Introduction ¶1Find in source

“Mapping symptoms to imaging findings suggests central nervous system origins for the migraine attack , with implications for understanding the pathophysiology and, importantly, where to target therapies.”

Introduction ¶4Find in source

“Although our results suggest a consistent amelioration of common prodromal symptoms after ubrogepant compared with placebo, additional studies specifically designed to evaluate the effect of acute treatment on prodromal symptoms are warranted.”

LimitationsFind in source

The trial is a randomized, double-blind, placebo-controlled crossover design with an interactive web response system for randomization and identical blister cards to maintain blinding. Sample size was pre-specified with 95% power for the primary endpoint. Inclusion/exclusion criteria are detailed, and the mITT population is defined. Outlier handling is addressed through the pre-specified analysis population and censoring analyses. Controls are inherent in the placebo comparison. Independent replication is not applicable for a single pivotal trial.

Sub-criteria

controlsADEQUATE

power analysisADEQUATE

blinding levelsADEQUATE

outlier handlingADEQUATE

randomization unitADEQUATE

inclusion exclusionADEQUATE

randomization methodADEQUATE

replicate distinctionN/A

independent replicationN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 85% conf

The trial design is adequately described: randomized, double-blind, placebo-controlled, crossover, with a prespecified additional endpoint on prodromal symptoms.

PASSReviewer 2· 95% conf

The trial design is rigorous with clear randomization, blinding, and pre-specified endpoints, though some details are referenced to prior publications.

Evidence

“An automated interactive web response system was used to manage randomization, which occurred at visit 2. To maintain the blind, identical blister cards were dispensed at visit 2 and the visit after treatment of the first qualifying prodrome event (visit 3).”

MethodsFind in source

“480 participants in the mITT population were estimated to provide 95% power to determine a 16-point treatment difference in response rate for the primary endpoint, using a two-sided 5% significance level .”

Statistical analysisFind in source

“Eligible participants were adults (aged 18–75 years), female or male (based on self-report) with at least a 1-year history of migraine with or without aura consistent with a diagnosis according to the International Classification of Headache Disorders , 3rd edn and a history of two to eight migraine attacks per month with moderate-to-severe headache in each of the 3 months before screening.”

MethodsFind in source

The paper reports sex, age, race, ethnicity, BMI, and migraine characteristics in Table 1. Since both sexes are enrolled, sex_justified is not applicable. Age, weight (BMI), and health status are reported. Demographics are comprehensive. Species/strain and housing conditions are not applicable for a human trial.

Sub-criteria

demographicsADEQUATE

sex reportedADEQUATE

sex justifiedN/A

age weight healthADEQUATE

housing conditionsN/A

species strain sourceN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 85% conf

Demographics are reported for the safety population (n=480): mean age 42.3 years, 87.7% female, 88.1% White, 92.7% non-Hispanic.

Evidence

paraphrase[Table 1]

“Sex, n (%) | Male 59 (12.3) | Female 421 (87.7)”

paraphrase[Table 1]

“Age, mean (s.d.), years | 42.3 (12.9)”

PASSReviewer 2· 90% conf

Demographic and clinical characteristics are well reported, including age, sex, race, ethnicity, and migraine history.

Evidence

“Participants had a mean age of 42.3 years (Table ). Most of the participants in the safety population were female (87.7%, n = 421 of 480), with most identifying as White (88.1%, n = 423 or 480) and non-Hispanic (92.7%, n = 445 or 480; Table ).”

Table 1Find in source

The paper states that an Independent Ethics Committee or IRB (named Advarra or University of Utah IRB) approved the study, and all patients provided written informed consent. Compliance with ICH guidelines and the Declaration of Helsinki is stated. The trial is registered on ClinicalTrials.gov.

Sub-criteria

iacuc statementN/A

informed consentADEQUATE

irb ethics statementADEQUATE

regulatory complianceADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

Ethics approval is reported: a named IRB approved the protocol, written informed consent was obtained, and the trial is registered (NCT04492020).

Evidence

“The Independent Ethics Committee or Institutional Review Board (IRB; that is, Advarra or University of Utah IRB) at each study site approved the study protocol, informed consent forms and recruitment materials before patient enrollment.”

MethodsFind in source

“All patients provided written informed consent before screening.”

MethodsFind in source

paraphrase[Methods, Standard protocol approvals, registrations and patient consents]

“The study is registered with ClinicalTrials.gov (NCT04492020).”

PASSReviewer 2· 95% conf

Ethical approvals, informed consent, and regulatory compliance are clearly documented.

Evidence

paraphrase[Methods, Standard protocol approvals, registration and patient consents]

“The studies were conducted in accordance with the ICH guidelines, applicable regulations and the Declaration of Helsinki.”

MethodsFind in source

The investigational product ubrogepant is named with dose (100 mg) and manufacturer (AbbVie). The statistical software SAS v9.4 is identified. No antibodies, cell lines, or other biological reagents are used, so those criteria are not applicable.

Sub-criteria

mycoplasma testingN/A

reagents identifiedADEQUATE

organisms identifiedN/A

antibodies identifiedN/A

cell line authenticationN/A

software tools identifiedADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 80% conf

The investigational product (ubroge Tsai 100 mg) is identified by name, dose, and manufacturer (AbbVie); the analysis software (SAS v9.4 or newer) is identified. No wet-lab reagents PMCID resources are used.

Evidence

paraphrase[Methods, Trial design, paragraph 1]

“Participants in sequence A received placebo to treat the first qualifying prodrome event and u dekametersalakip 100 mg to treat the second qualifying event, whereas participants in sequence B received ubrogepant 100 mg to treat the first qualifying prodrome McConnell山庄 event and placebo to treat the second qualifying event.”

paraphrase[Methods, Statistical analysis, paragraph 1]

“All symptom efficacy analyses were done using SAS software, v.9.4 or newer (SAS Institute, Inc.).”

PASSReviewer 2· 90% conf

The investigational product (ubrogepant) is adequately identified, and statistical software is specified.

Evidence

“ubrogepant 100 mg, a calcitonin gene-related peptide receptor antagonist”

AbstractFind in source

“All symptom efficacy analyses were done using SAS software, v.9·4 or newer (SAS Institute, Inc.).”

Statistical analysisFind in source

The analysis uses generalized linear mixed models with ORs and 95% CIs, which is appropriate for the crossover design. Tests are named, and software is identified. Effect sizes with CIs are reported, satisfying the effect_sizes_ci criterion. Exact p-values are not reported, but the paper reports by estimation (ORs with CIs), which is acceptable. Assumptions are handled by the model choice. Data presentation includes figures and tables with per-group n. Mathematical plausibility checks were not possible for most outcomes due to continuous data and model-based estimates, but no inconsistencies were found.

Sub-criteria

tests namedADEQUATE

exact p valuesN/A

effect sizes ciADEQUATE

data presentationADEQUATE

software identifiedADEQUATE

assumptions verifiedADEQUATE

mathematical plausibilityN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 80% conf

Statistical reporting is largely adequate: tests are named, effect sizes with 95% CIs are reported, and the analysis is by estimation with ORs and CIs. Exact p-values are not reported (only ORs with 95% CIs), which is acceptable estimation-style reporting.

Evidence

paraphrase[Methods, Statistical analysis, paragraph 1]

“The absence of symptomsјединачна symptoms of any intensity at each timepoint was analyzed using a generalized linear mixed model (GLMM) in the observed binary response variable.”

paraphrase[Results, paragraph 1 and Figure 2]

“odds ratio (OR) = 1.72 (95% CI = 1.13–2.61)”

paraphrase[Methods, Statistical analysis, paragraph 1]

“All symptom efficacy analyses were performed using SAS software, v.9.4 or newer (SAS Institute, Inc.).”

PASSReviewer 2· 90% conf

Statistical methods are appropriate and well-described, with effect sizes and confidence intervals reported; p-values are not the primary focus.

Evidence

“ORs (95% CIs) were based on the GLMM with treatment group, treatment period and pre-dose baseline prodromal symptom intensity as categorical fixed effects.”

Statistical analysisFind in source

“All symptom efficacy analyses were done using SAS software, v.9·4 or newer (SAS Institute, Inc.).”

Statistical analysisFind in source

The data availability statement names AbbVie's Vivli platform with a URL, states that anonymized individual and trial-level data can be requested by qualified researchers after review of a proposal, SAP and a data-sharing agreement, and that data are accessible for 12 months with possible extensions. This is a concrete managed-access route, adequate for identifiable patient data. No custom analysis code was written (the analysis used SAS), so code_sharing is not applicable.

Sub-criteria

code sharingN/A

accession numbersN/A

repository depositN/A

data availability statementADEQUATE

Per reviewer (2) — the votes behind the verdict

WARNReviewer 1· 75% conf

A data-availability statement is present and names a managed-access route (Vivli) with conditions and duration, which is adequate for identifiable patient data. No code was written for this trial, so code sharing is not applicable.

Evidence

“AbbVie is committed to responsible data sharing regarding the clinical trials that we sponsor. This includes access to anonymized, individual and trial-level data (analysis datasets), as well as other information (for example, protocols, clinical study reports or analysis plans), as long as the trials are not part of an ongoing or planned regulatory submission.”

Data availabilityFind in source

PASSReviewer 2· 90% conf

Data availability is clearly stated with a concrete managed-access route via Vivli, and no bespoke code is mentioned.

Evidence

“Data requests can be submitted at any time after approval in the USA and Europe and after acceptance of this manuscript for publication. The data will be accessible for 12 months, with possible extensions considered. For more information on the process or to submit a request, visit the link https://vivli.org/ourmember/abbvie (https://vivli.org/ourmember/abbvie/) , then select ‘Home’.”

Data availabilityFind in source

Methods are detailed enough for replication. The trial is registered (NCT04492020). A reporting summary is mentioned. All pre-specified outcomes are reported, including negative results (e.g., dizziness). Limitations are discussed, including lack of control for multiple comparisons. Conclusions are proportional, acknowledging the exploratory nature. Funding and competing interests are disclosed.

Sub-criteria

funding coiADEQUATE

trial registrationADEQUATE

reporting guidelineADEQUATE

methods completenessADEQUATE

all outcomes reportedADEQUATE

limitations discussedADEQUATE

conclusions proportionalADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 80% conf

Reporting is largely complete: methods are detailed, the trial is registered, limitations are discussed, and conclusions are proportional. No reporting guideline (CONSORT) is referenced, and the trial is not prospectively registered in a WHO primary registry.

Evidence

paraphrase[Methods, Standard protocol approvals, registrations and patient consents]

“The study is registered with ClinicalTrials.gov (NCT04492020).”

paraphrase[Discussion, Limitations, paragraph 1]

“Paraphrase: The authors note the trial was not designed to evaluate prodrom kinainitan effect on prodromal symptoms; these were prespecified additional endpoints analyzed outside the hierarchical gatekeeping, so not controlled for multiple comparisons; and that participants dosed at the onset of confidence rather than at first recognition of prodromal symptoms.”

paraphrase[Discussion, final paragraph]

“Reversing these symptoms with a gepant emphasizes the importance of the brain in migraine and offers the promethe Dwight possibility that targeting central nervous system mechanisms will be a fruitful path to new therapeutics in this common and disabling disorder.”

PASSReviewer 2· 90% conf

The manuscript is transparent with detailed methods, trial registration, limitations, and funding/COI statements.

Evidence

“The study is registered with ClinicalTrials.gov ( NCT04492020 (https://clinicaltrials.gov/ct2/show/NCT04492020) ).”

MethodsFind in source

“These analyses were outside the hierarchical gatekeeping procedure to control for type-1 error and were therefore not controlled for multiple comparisons.”

LimitationsFind in source

“AbbVie funded the present study and participated in the study design, research, analysis, data collection, interpretation of data, reviewing and approval of the publication.”

AcknowledgementsFind in source

Registered (1 ID: ClinicalTrials.gov). No reporting guideline cited.

ClinicalTrials.gov

NCT04492020

Broken references and links

None found

References checked against Crossref, OpenAlex and Retraction Watch for retractions and resolvability, plus declared data and code links probed for whether they resolve to content matching the paper.

Checked — nothing surfaced.

Checked 49 references by DOI: 2 verified — 47 no DOI (shown, not verified).

NO DOI
Pathophysiology of migraine: a disorder of sensory processing
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Migraine
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
The International Classification of Headache Disorders, 3rd edition
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Vasoactive peptide release in the extracerebral circulation of humans during migraine headache
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
The trigeminovascular system and migraine: studies characterizing cerebrovascular and neuropeptide changes seen in humans and cats
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
The migraine premonitory phase
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Premonitory symptoms in migraine: an electronic diary study
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
The premonitory symptoms (prodrome): a tertiary care study of 893 migraineurs
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
The prevalence of premonitory symptoms in migraine: a questionnaire study in 461 patients
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
The prevalence of premonitory symptoms in paediatric migraine: a questionnaire study in 103 children and adolescents
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Characterising the premonitory stage of migraine in children: a clinic-based study of 100 patients in a specialist headache service
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Brain activations in the premonitory phase of nitroglycerin triggered migraine attacks
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Longitudinal neuroimaging over 30 days: temporal characteristics of migraine
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Insights into migraine attacks from neuroimaging
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Extracranial origin of headache
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Domperidone in the prevention of complete classical migraine
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Dihydroergotamine nasal spray in prevention and treatment of migraine attacks: two controlled trials versus placebo
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Ubrogepant for the treatment of migraine attacks during the prodrome: a phase 3, multicentre, randomised, double-blind, placebo-controlled, crossover trial in the USA
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Characterization of ubrogepant: a potent and selective antagonist of the human calcitonin gene-related peptide receptor
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Efficacy of ubrogepant for the treatment of migraine symptoms during the prodrome (premonitory phase): results from the PRODROME trial
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
A Manual of Diseases of the Nervous System
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Migraine prodromes separated from the aura: complete migraine
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Neurovascular disturbances in headache patients
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Premonitory and resolution symptoms in migraine: a prospective study in 100 unselected patients
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Premonitory symptoms in migraine: a cross-sectional study in 2714 persons
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
To what extent are patients with migraine able to predict attacks?
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
On megrim, sick-headache, and some allied disorders, a contribution to the pathology of nerve-storms
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Biological insights from the premonitory symptoms of migraine
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Neuropeptide Y inhibits the trigeminovascular pathway through NPY Y1 receptor: implications for migraine
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Neuropeptide Y in normal eating and in genetic and dietary-induced obesity
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Pharmacological modulation of ventral tegmental area neurons elicits changes in trigeminovascular sensory processing and is accompanied by glycemic changes: Implications for migraine
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
The migraine generator revisited: continuous scanning of the migraine cycle over 30 days and three spontaneous attacks
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Photic hypersensitivity in the premonitory phase of migraine—a positron emission tomography study
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Activation of dura-sensitive trigeminal neurons and increased c-Fos protein induced by morphine withdrawal in the rostral ventromedial medulla
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Changes in brainstem pain modulation circuitry function over the migraine cycle
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Serotonin and migraine
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Changes in cerebral blood flow velocity after treatment with sumatriptan or placebo and implications for the pathophysiology of migraine
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Sumatriptan can inhibit trigeminal afferents by an exclusively neural mechanism
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Vasodilation out of the picture as a cause of migraine headache
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Sumatriptan pharmacokinetics in the spinal fluid following oral administration of the drug
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Is selective 5-HT1F receptor agonism an entity apart from that of the triptans in antimigraine therapy?
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Orally administered atogepant was efficacious, safe, and tolerable for the prevention of migraine: results from a phase 2b/3 study
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Lasmiditan mechanism of action—review of a selective 5-HT1F agonist
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
In vivo quantification of calcitonin gene-related peptide receptor occupancy by telcagepant in rhesus monkey and human brain using the positron emission tomography tracer [ 11 C]MK-4232
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Efficacy and tolerability of MK-0974 (telcagepant), a new oral antagonist of calcitonin gene-related peptide receptor, compared with zolmitriptan for acute migraine: a randomised, placebo-controlled, parallel-treatment trial
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
The migraine postdrome: an electronic diary study
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Statistical Principles for Clinical Trials E9
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).

1 data/code link checked; 1 live.

datahttps://vivli.org/ourmember/abbvieLIVEHTTP 200
Resolves, but the content could not be matched to the paper.

Copyediting

3 minor

Wording, consistency and formatting errors that need correcting before submission.

No major wording or formatting errors. 3 minor suggestions below.

3 copyedit issues flagged: mostly typo, consistency, clarity.

MINORtypoAbstract
“ubrogepant 100 mg, a calcitonin gene-related peptide receptor antagonist, dosed during the premonitory (prodromal) phase of migraine, prevented development of headache and resolved prodromal symptoms.”
→ Consider rephrasing for clarity: '...prevented the development of headache and resolved prodromal symptoms.'
Minor grammatical issue.
MINORconsistencyResults, Participants and baseline characteristics
“Most of the participants in the safety population were female (87.7%, n = 421 of 480), with most identifying as White (88.1%, n = 423 or 480) and non-Hispanic (92.7%, n = 445 or 480; Table ).”
→ Change 'or' to 'of' in 'n = 423 or 480' and 'n = 445 or 480'.
Typographical error.
MINORclarityMethods, Trial design
“Each blister card contained two tablets of either placebo or ubrogepant 50 mg.”
→ Clarify that two 50 mg tablets constitute the 100 mg dose.
Potential confusion about dose.

Kaimen Rigor Action ItemsFinal pass before journal submission

The published work is robust and well-reported. An informed reader should weigh the exploratory nature of the prodromal-symptom endpoint (outside hierarchical gatekeeping, no multiplicity control) and the predominantly White, female sample when interpreting generalizability. No erratum appears warranted based on the checks performed; minor copyedit issues (e.g., 'or' vs 'of' in Table 1) could be corrected in a future revision.

1.
MEDIUMcopyedit
In Results, Participants and baseline characteristics, change 'n = 423 or 480' and 'n = 445 or 480' to 'n = 423 of 480' and 'n = 445 of 480'.
Typographical error that could confuse readers about the denominator.
2.
MEDIUMcopyedit
In Methods, Trial design, clarify that each blister card contained two tablets of ubrogepant 50 mg to constitute the 100 mg dose.
Avoids confusion about the administered dose.
3.
MEDIUMreporting
Add a CONSORT flow diagram and checklist reference to the Methods to explicitly document reporting guideline adherence.
Enhances transparency and aligns with standard reporting expectations for RCTs.
4.
MEDIUMstatistics
Consider reporting exact p-values alongside ORs and 95% CIs for the primary and secondary endpoints.
Provides additional transparency for readers who expect p-values, even though estimation-based reporting is acceptable.
5.
MEDIUMreporting
State explicitly in the Methods that the prodromal-symptom endpoint was a prespecified additional endpoint analyzed outside the hierarchical gatekeeping, and note the absence of multiplicity control.
Clarifies the exploratory nature of the endpoint and the risk of type I error.
6.
LOWreporting
Add the trial registration number (NCT04492020) to the abstract.
Improves discoverability and transparency.
7.
LOWreporting
Describe the randomization sequence generation (e.g., block size) in more detail in the Methods.
Provides fuller methodological detail for replication.
8.
LOWdata code
Consider including a statement about the availability of the statistical analysis plan or protocol in a public repository.
Further enhances transparency and reproducibility.
9.
LOWstatistics
Report the number of participants with missing data for each outcome timepoint.
Allows readers to assess the impact of missing data on results.
10.
LOWreporting
Discuss the generalizability of the findings to diverse populations, given the predominantly White and female sample.
Addresses potential limitations in external validity.
11.
LOWreporting
Clarify the role of the sponsor in data analysis and interpretation.
Provides transparency about potential conflicts of interest.
12.
LOWstatistics
Add a note on whether any sensitivity analyses were pre-specified or post-hoc.
Clarifies the analytic plan and reduces risk of selective reporting.

Full text (46,723 chars)Analyzed: Aug 15, 2026

RigorReviewer 1

RigorReviewer 2

RigorPre-Submission Reviewer

CopyeditAgent Scribe

CitationsCitation Integrity

StatisticsStatistics Consistency

ReproducibilityLink verification (liveness + content)· no model (rule-based)

PreregistrationDeterministic check· no model (rule-based)

The star rating is the report’s one-glance summary. Every paper starts at 5★ and loses stars for the concrete problems the review finds — so a rating is never a vague average, it’s a running total you can read line by line under “How this rating was calculated.”

How stars are deducted

Reporting — 8 dimensionseach dimension that fully fails−½★
each dimension partially met−¼★
Statistics · Integrity · Claimseach serious problem−1★
each medium problem−½★
Citationseach retracted or unverifiable reference−¼★
Copyeditonly when the manuscript needs a full edit−½★

The rating never drops below 1★, and a demonstrable critical failure (an impossible statistic, a proven ethics violation) caps it at 1★ on its own — so the stars can never look healthy when the verdict is CRITICAL.

The rating draws on a panel of agents. Three independent Kaimen Rigor reviewers grade the eight dimensions below across several independent passes (the shown verdict is their majority vote — steadier than any single run), isolate the paper’s major claims and check its own evidence backs them, and flag integrity concerns. Alongside them, a citation agent resolves every reference against Crossref, OpenAlex, and Retraction Watch; a statistics agent recomputes reported tests; and rule-based checks verify that declared data/code links actually resolve. Full text is required — an abstract-only submission is not analyzed.

The eight reporting dimensions

Scientific PremisePrior work, rationale, and how it addresses gaps.

Study Design & RigorRandomization, blinding, power, controls, replication.

Biological VariablesSex, age, species/strain, housing, demographics.

Ethical ApprovalsIRB/IACUC approval, informed consent, regulatory compliance.

Key ResourcesAntibodies, cell lines, organisms, software — identified with persistent IDs.

Statistical ReportingNamed tests, exact p-values, effect sizes, plausible summary stats.

Data & Code AvailabilityAvailability statements, repositories, accession numbers, shared code.

Reporting TransparencyMethods, registration, guidelines, outcomes, limitations, funding/COI.

Graded against NIH, MDAR, ARRIVE 2.0, CONSORT, EQUATOR, and RRID guidelines. A dimension that doesn’t apply to the study type is skipped, never penalized.

This Kaimen Rigor review is model-assisted and is not a substitute for formal expert review. It complements human evaluation by surfacing potential methodological concerns — verify each finding against the source.

Ubrogepant for the treatment of migraine prodromal symptoms: an exploratory analysis from the randomized phase 3 PRODROME trial.

Goadsby PJ, Ailani J, Dodick DW, Starling AJ, Liu C, Liu Y, Yu SY, Smith JH, Brand-Schieber E, Trugman JM

DOI

10.1038/s41591-025-03679-7

Record issued

2026-08-15

Engine

7.39.0

Exported

2026-09-22