Migraine prevention: Towards patient-centric management of chronic migraine

At the 2022 American Headache Society Scottsdale Headache Symposium, November 17–22, Scottsdale, Arizona, healthcare practitioners met to share practical, clinical, evidence-based information on the diagnosis, management and treatment of headache patients. In an industry-supported symposium, leading neurologists discussed how new preventive medicines may provide better management of patients with high frequency, disabling migraine caught in a cycle of worsening migraine despite high acute medication use. Understanding patient needs and directly incorporating their input into care plans are important strategies for successful partnerships that support patient-centric outcomes. And bridging any gaps between clinician goals and patient needs will facilitate a successful migraine prevention plan.

Migraine unmet needs are unchanging

Dr Amaal Starling, Mayo Clinic College of Medicine, identified that in spite of major treatment advances, approaches to care and migraine unmet needs have remained consistent for decades. Patients with frequent attacks, high acute medication use, and worsening disease are especially in need of better management.

A 2021 online survey of 550 US adults currently experiencing high frequency migraine and high acute medication use, identified several areas in which healthcare practitioners can provide better care, including an improved understanding of migraine and a broader awareness of patients’ mental health and wellbeing.1 Despite recent treatment advances, many people with high frequency migraine are dissatisfied with their care and struggling to achieve their health goals.

“Better migraine prevention will likely lead to improvement in acute treatment optimization.” – Dr Amaal Starling, Mayo Clinic College of Medicine


The cycle of migraine chronification and medication overuse

Medication overuse is part of the cycle of worsening and a risk factor for the transition from episodic to chronic migraine.2,3 Medication overuse headache (MOH) develops as patients increase the quantity and frequency of their medication usage in order to gain control of their headache disorder.3,4

Dr Michael J. Marmura, Jefferson Headache Center, explained that MOH can be managed by reducing acute medication use and initiating preventive therapy with treatments of proven efficacy.5-8 Migraine prevention with an injectable calcitonin gene-related peptide monoclonal antibody is demonstrated to reduce acute headache medication and headache frequency to below diagnostic thresholds in patients with chronic migraine and MOH.8

“Preventive therapy for migraine really needs to match the patient’s needs.” Dr Michael J. Marmura, Jefferson Headache Center


Bridging the gap between clinician goals and patient needs

Professor Robert Cowan, Stanford University School of Medicine, considered that understanding patient needs and directly incorporating their input into care plans are important strategies for partnerships that support patient-centric goals. Although this is well understood,9 it can be challenging to enact in practice, he added.

While clinicians may have very tangible goals for each patient, patients themselves often have additional needs, and increased understanding of patient preferences for medication attributes will help clinicians better match patients with treatments that align with their preferences. Among 604 US adults with migraine, the three most important attributes of preventive treatment were identified as mode of administration, durability of effectiveness, and speed of onset.10

“Migraine treatment goals need to be patient-orientated rather than disease-orientated.” Professor Robert Cowan, Stanford University School of Medicine


Towards patient-centric migraine care

Professor Cowan summarized that understanding the patient’s experience, migraine burden, functional impairment, and treatment goals as a basis for shared decision making are especially important when partnering with a patient to initiate or modify an individualized care plan. In addition, taking time to explain the diagnosis with the patient and providing education can help to improve patient engagement and outcomes.


Educational financial support for this Satellite symposium was provided by Lundbeck A/S

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. Starling AJ, Cady R, Buse DC, et al. Health and treatment concerns and stigma among US adults with high-frequency headache and high acute medication use: Results of the “High Frequency Migraine Report Card” population-based survey. Poster presented at: BRAINWeek 2022, September 28-30, 2022, Las Vegas, NV.
  2. Buse DC, Greisman JD, Baigi K, et al. Migraine progression: a systematic review. Headache. 2019;59(3):306-338.
  3. Diener H-C, Marmura MJ, Tepper SJ, et al. Efficacy, tolerability, and safety of eptinezumab in patients with a dual diagnosis of chronic migraine and medication-overuse headache: Subgroup analysis of PROMISE-2. Headache. 2021;61(1):125-136.
  4. Headache Classification Committee of the International Headache Society (IHS). Cephalalgia. 2018;38(1):1-211.
  5. Evers S, Jensen R; European Federation of Neurological Societies. Treatment of medication overuse headache - guideline of the EFNS headache panel. Eur J Neurol. 2011;18(9):1115-1121.
  6. Carlsen LN, Munksgaard SB, Nielsen M, et al. Comparison of 3 treatment strategies for medication overuse headache: a randomized clinical trial. JAMA Neurol. 2020;77(9):1069-1078.
  7. Diener HC, Antonaci F, Braschinsky M, et al. European Academy of Neurology guideline on the management of medication-overuse headache. Eur J Neurol. 2020;27 (7):1102-1116.
  8. Marmura M, Diener HC, Cowan RP, et al. Preventive migraine treatment with eptinezumab reduced acute headache medication and headache frequency to below diagnostic thresholds in patients with chronic migraine and medication-overuse headache. Headache. 2021;61:1421-1431.
  9. Ailani J, Burch R, Robbins M, et al. The American Headache Society consensus statement: update on integrating new migraine treatments into clinical practice. Headache. 2021;61(7):1021-1039.
  10. Schwedt T, Martin A, Kymes S, et al. Patient preferences for attributes of advanced migraine prevention medications: findings from a discrete choice experiment. Presented at the 64th Annual Scientific Meeting of the American Headache Society, June 9-12, 2022; Denver, CO.