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Limited direct comparative evidence exists to guide use of medications for migraine prevention, especially comparing established drugs with newer, migraine-specific calcitonin gene-related peptide (CGRP)–targeting agents. Topiramate is a widely used anticonvulsant, recently recommended for third-line prevention of episodic migraine by the American College of Physicians. To compare the tolerability (primary outcome), safety, and efficacy of the CGRP receptor antagonist atogepant and of topiramate directly, researchers conducted an industry-funded, multinational, 24-week, phase 3b, randomized, active-control trial. They assigned 545 participants with 4 or more mean migraine days per month to receive 60 mg of atogepant or 50 to 100 mg o…