Migraine preventive therapy—Who is eligible? What are the goals?

Migraine is associated with a substantial economic cost, yet is underdiagnosed and undertreated, and often aggravated by medication overuse. New effective and safe preventive therapies are now available and promise to transform the lives of patients with migraine. Patient eligibility for these new preventives and the treatment goals were discussed at a satellite symposium at EAN 2021.

Migraine is associated with substantial socioeconomic burden,1 said Professor Zaza Katsarava, University of Essen-Duisberg, Germany. So, there is no doubt that migraine should be treated.

Migraine is underdiagnosed and undertreated

 

Who is eligible for migraine preventive therapy?

A patient with migraine is eligible for preventive treatment if they experience at least 4 monthly headache days/month resulting in some disability. This is according to the American Headache Society (AHS) consensus position statement on integrating new migraine treatments into clinical practice.2

However, migraine is underdiagnosed and undertreated,2,3 with only 2–14% of patients eligible for preventive therapy receiving a preventive.4

Less than 14% of patients eligible for preventive therapy receive a preventive

 

What are the goals of preventive treatment?

Professor Hans-Christoph Diener, University of Essen-Duisberg, Germany explained that the goals for migraine preventive treatment include:

  • Reduction in the frequency of migraine episodes
  • Reduction in the severity of episodes
  • Shorter duration of attacks
  • Fewer non-headache symptoms
  • Reduced use of acute medication2

Therapies targeting calcitonin gene-related peptide are meeting the goals for preventive therapy

He highlighted evidence demonstrating that new therapies targeting calcitonin gene-related peptide (CGRP) are meeting the goals of preventive therapy.5 In patients with episodic or chronic migraine, anti-CGRP monoclonal antibody:

  • Reduces the frequency of migraine headache days6
  • Reduces headache severity7
  • Reduces headache duration7
  • Alleviates migraine-related symptoms8
  • Potentially alleviates disabling non-pain symptoms6

 

The challenge of medication overuse

Medication overuse worsens migraine

The management of patients with migraine is complicated by medication overuse.

In the United States, 23% of people with chronic headache use acute medications every day,9 and approximately 15% of people with migraine meet the criteria for medication overuse,10 said Professor Diener.

It is important to address any medication overuse when managing patients with migraine, he added, because of its association with medication overuse headache, disability, and migraine progression,10 a lower quality of life,11 and higher socioeconomic cost.12

 

This satellite symposium was funded by Teva.

 

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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.

References
  1. Seddick AH, et al. The socioeconomic burden of migraine: An evaluation of productivity losses due to migraine headaches based on a population study in Germany. Cephalalgia 2020;40:1551–60.
  2. American Headache Society Consensus Statement. The American Headache Society position statement on integrating new migraine treatments into clinical practice. Headache 2019;59:1–18.
  3. Ryvlin P, et al. Current clinical practice in disabling and chronic migraine in the primary care setting: results from the European My-LIFE anamnesis survey. BMC Neurology 2021;21:1.
  4. Katsarava Z, et al. Poor medical care for people with migraine in Europe – evidence from the Eurolight study. J Headache Pain 2018;19:10.
  5. Sacco S, et al. European headache federation guideline on the use of monoclonal antibodies acting on the calcitonin gene related peptide or its receptor for migraine prevention. J Headache Pain 2019;20:6.
  6. Ament M, et al. Effect of galcanezumab on severity and symptoms of migraine in phase 3 trials in patients with episodic or chronic migraine. J Headache Pain 2021;22:6.
  7. Ashina M.  Early reductions in headache severity and duration with fremanezumab treatment in the randomized, double-blind phase 3b FOCUS study. Presented at AAN 2021. Abstract 021. Available at: https://www.aan.com/MSA/Public/Events/Details/13774. Accessed 25 June 2021.
  8. Mechtler L. Impact of fremanezumab on migraine-associated symptoms in patients with episodic and chronic migraine and documented inadequate response to 2–4 classes of migraine preventive medications during the open-label period of the Phase 3b FOCUS study. Presented at AAN 2020. Abstract 6-007. Available at: https://www.aan.com/MSA/Public/Events/Details/9608. Accessed 25 June 2021.
  9. Kristoffersen ES, Lundqvist C. Medication-overuse headache: epidemiology, diagnosis and treatment. Ther Adv Drug Saf 2014;5: 87–99.
  10. Schwedt T, et al. Factors associated with acute medication overuse in people with migraine: results from the 2017 migraine in America symptoms and treatment (MAST) study. J Headache Pain 2018;19:38.
  11. Benz T, et al. Health and quality of life in patients with medication overuse headache syndrome after standardized inpatient rehabilitation. Medicine 2017;96:47(e8493).
  12. Ford JH, et al. Treatment patterns and predictors of costs among patients with migraine: evidence from the United States medical expenditure panel survey. J Med Econ 2019;22:849–58.
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