Migraine: Your patient, your partner

Proactive prevention strategies that align research findings with patient needs and goals can prevent the cycle of worsening migraine and medication overuse. Experts at AAN 2023 provided practical tips on how to provide such proactive care for people with high frequency, worsening migraine and incorporate patient needs and goals into care plans.

Proactive prevention strategies are key to prevent the chronification of migraine

"Episodic migraine that is not effectively managed can progress to new-onset chronic migraine",1 said Professor Amaal Starling, Mayo Clinic College of Medicine, Phoenix, AZ. Many factors contribute to a cycle of worsening migraine and migraine chronification, including medication overuse.2

Factors leading to migraine chronification include medication overuse

"Individualize migraine prevention goals for each patient", said Professor Starling, "and aim to bridge the gap between intervention goals and patient goals".

  • The intervention goals aim to improve migraine, reduce the need for acute treatment, and improve quality of life.3
  • The patient goals include freedom from pain and associated symptoms, fast onset of prevention with limited side effects, and minimal need for rescue medication.4

Proactive prevention strategies that align research findings with the patient’s needs and goals can prevent migraine chronification

Once an individual patient’s needs and goals have been determined, proactive prevention strategies that align research findings with these needs and goals can be implemented to prevent the cycle of worsening disease and medication overuse.


Key questions to ask patients

The Patient Global Impression of Change is a valuable migraine monitoring tool

"Ask patients focused proactive questions and actively listen to their responses to assess patient-reported outcomes, disease burden, and the overall patient experience of migraine" said Professor Robert Cowan, Stanford University School of Medicine, Stanford, CA.

"The Patient Global Impression of Change (PGIC) is a straightforward and valuable migraine monitoring tool", he said. It is a one-question — “Since your last visit, how would you describe the change (if any) in your migraine and its impact?” —self-reported assessment of change.

Understand the patient’s needs and incorporate them into a proactive, preventive care plan

Professor Robert Cowan suggested that other useful patient-centered questions to consider asking to inform treatment are:

  • Since your last visit, how would you describe the change (if any) in your migraine and its impact?
  • How many headache-free days have you had over the past 3 months?
  • Over the past 3 months, what has been the most bothersome symptom associated with your migraine?
  • What would you most like to accomplish during your visit today?

Both experts emphasized that an effective partnership with a patient with migraine that supports the patient’s treatment goals is key. This is achieved by understanding the patient’s needs and incorporating them into a proactive, preventive care plan.


Educational financial support for this Industry Therapeutic Update was provided by Lundbeck.


AAN : American Academy of Neurology
AZ : Arizona
CA : California
PGIC : Patient Global Impression of Change 

BE-NOTPR-0323 approval date 06/2023

Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.

  1. Bigal ME, Lipton RB. Migraine chronification. Curr Neurol Neurosci Rep. 2011;11(2):139–148. doi:10.1007/s11910-010-0175-6
  2. Buse DC, Greisman JD, Baigi K, Lipton RB. Migraine progression: A systematic review. Headache. 2019;59(3):306–338. doi:10.1111/head.13459
  3. Ailani J, Burch RC, Robbins MS; Board of Directors of the American Headache Society. The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache. 2021;61(7):1021-1039. doi:10.1111/head.14153
  4. Tepper SJ, Spears RC. Acute treatment of migraine. Neurol Clin. 2009;27(2):417-427. doi:10.1016/j.ncl.2008.11.008
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