Migraine prevention is important to patients and clinicians. A recent Consensus Statement on treatment goals for migraine prevention, initiating preventive therapies in the acute attack, and patient-based assessment of treatment efficacy were all discussed at this AAN Virtual 2022 Industry Update session.
Why is prevention important?
Professor Dawn Buse (Albert Einstein College of Medicine, New York, USA) began by explaining how inadequate treatment of migraines may have long-term implications on pathophysiology and clinical symptoms and outcomes1,2. This can result in:
Inadequate treatment of migraines may have long-term implications on pathophysiology and clinical outcomes
- Worsening of migraine frequency1
- Increased severity of symptoms2,3
- Increased acute medication use and reduced overall effectiveness of medications4,5
- Increases in disability and comorbidities, and decreased health-related quality of life6
Increased disease severity may correlate with structural brain alterations7, and alterations in neuropeptide levels8 and neuronal activation and function9.
One study of the relative importance to patients of different outcomes from a potential new treatment showed that, after ‘take away the headache’, factors weighted most highly were preventive goals of ‘prevent the attack from carrying through’ and ‘make sure no other attack follows’10.
What should be considered?
Intervening early to prevent or reduce long-term consequences is an important component of effective migraine management
Intervening early to prevent or reduce long-term consequences is therefore an important component of effective migraine management explained Prof Buse. This should be individualized to the particular patient, if possible, as each will come with their own specific migraine and medical history.
Comorbidities are common, with anxiety, depression, chronic pain, arthritis, hypertension, hypercholesterolaemia, and allergies each reported by over a third of patients with migraine11. Comorbidities may be important in the transition from episodic to chronic migraine12, as is medication overuse headache12.
What are the goals?
The AHS put together a Consensus Statement in 202113 listing key overall treatment goals to be considered in migraine prevention, including:
- Reduce attack frequency, severity, duration, and severity
- Reduce reliance on poorly tolerated, ineffective, or unwanted acute treatment
- Enable patients to manage their disease to enhance a sense of personal control
There is a continuing need to bridge the gap between healthcare professionals’ goals and the patient’s needs, as they may differ14.
What treatments are available?
Prevention of migraine attacks requires a personalized long-term multi-pronged approach. This should include non-pharmacological, lifestyle and educational components as well as pharmacological agents. The AHS Consensus Statement13 offers a helpful algorithm to aid discussions with patients. Preventive drug treatment can be considered or offered depending on number of headache days/month and degree of associated disability.
Prevention of migraine attacks requires a personalized long-term multi-pronged approach
Dr Jessica Ailani (Georgetown University, Washington DC, USA) and Dr Paul Winner (Nova Southeastern University, Ft. Lauderdale, USA) discussed results from recent clinical trials using CGRP-targeted therapies in migraine prevention15, including benefits of initiating preventive treatment during the acute attack16.
How is success measured?
Patient involvement allows specific goal-setting using patient-based assessments of headache impact
Prof Buse described how ‘treat to target’ is an important concept in any migraine prevention plan. Patient involvement in all decision making allows specific goal-setting using patient-based assessments of headache impact17. Targets are then assessed frequently by both patient and clinician to monitor progress, and treatments regularly adjusted if the target is not reached. This ensures that the individual patient’s self-report of the presence, severity, frequency, and impact of their headache is the basis for assessing the effectiveness of any therapeutic intervention17.
Educational financial support for this Satellite symposium was provided by Lundbeck.
AAN : American Academy of Neurology
USA : United States of America
AHS : American Headache Society
BE-NOTPR-0229, approval date 12/2022
