New migraine preventives meet patients’ expectations in the real world

During a satellite symposium at #WCN2021, leading experts discussed both doctor and patient expectations from migraine treatment and how new preventive medications can help doctors and patients to better manage the disease. Mounting evidence from randomized clinical trials and real-world data for the newly introduced calcitonin gene-related peptide (CGRP) monoclonal antibody (mAb) preventives suggest that patient expectations may at last be met.

Expanding goals of preventive treatment

The goals of preventive migraine treatment have recently been revised by the American Headache Society to include outcomes beyond reduction in migraine days, and are to:1,2

  • Reduce attack frequency, severity, duration, and disability
  • Improve responsiveness to and avoid escalation in use of acute treatment
  • Improve function and reduce disability
  • Improve health-related quality of life
  • Reduce headache-related distress and psychological symptoms.

Professor Dawn Buse, Albert Einstein College of Medicine, USA urged physicians to discuss treatment goals with patients emphasizing that effective doctor–patient communication plays a key role in evaluating and meeting an individual migraine patient’s needs. In discussion, physicians in the symposium audience agreed that the main goals of effective doctor–patient communication are to create a good interpersonal relationship, facilitate information exchange and to include the patient in decision making.

CGRP mAb preventives are associated with less migraine days, reduced migraine disability, and improved quality of life in real world evidence


Meeting the goals of migraine prevention

Data presented at the symposium showed an effect of CGRP mAbs beyond reduction in migraine days but also with reduction in disability and improvement in quality of life (QOL), along with data from real-life studies that confirm the results of randomized trials and show the effectiveness may even be higher in real life, with good safety and tolerability maintained.

CGRP mAb preventives allow increased work productivity and less missed work time

Professor Shuu-Jiun Wang, National Yang Ming Chiao Tung University, Taiwan, shared data showing that injectable migraine preventives deliver a significant reduction in migraine headache days and total pain burden in episodic and chronic migraine over 3 to 6 months (p<0.01).3,4 This is accompanied by improvements in migraine-specific QOL and migraine-associated disability as reported by people with migraine receiving CGRP mAb treatment for up to 6 months.5-7 An improvement in work productivity and reduction in missed work time was also reported among people with migraine with CGRP mAb preventive therapy.8

Most patients report their migraine condition as better since starting use of a CGRP mAb therapy

Associate Professor Piero Barbanti, San Raffaele University-IRCCS, Rome, Italy highlighted real-world evidence from the OVERCOME study in which 80% of US patients reported their migraine condition as better based upon the patient’s global impression of improvement since starting a CGRP mAb preventive.9 A real-world study of Italian patients with chronic migraine and prior treatment failure has reported an improvement in patient-reported outcomes following 3 to 6 months of CGRP mAb therapy.10 Furthermore, adherence to CGRP mAb preventive treatments is significantly higher than that seen with traditional oral preventives (p<0.001), supporting the view that adherence is improved by treatment effectiveness.11-13

Patients are more adherent to CGRP mAbs than other migraine preventives


Educational financial support for this Satellite symposium was provided by Lilly.

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. American Headache Society. Headache 2019;59:1–18.

2. Ailani J, et al. Headache 2021;61:1021–39.

3. Samaan K, et al. Cephalalgia 2019;39(Suppl 1):401: Abstract IHC-LB-033.

4. Ailani J, et al. J Headache Pain 2020;21:123.

5. Spierings ELH, et al. Headache 2021 [Epub ahead of print]; doi:10.1111/head.14196

6. Wang S-J, et al. Cephalalgia 2021 [Epub ahead of print]; doi:10.1177/03331024211024160.

7. Buse DC, et al. Cephalalgia 2018;38(10):1622–31.

8. Lanteri-Minet M, et al. J Neurol Neurosurg Psychiatry 2010;92(5):466–72.

9. Shapiro RE, et al. Cephalalgia 2020;40(Suppl 1):19: Abstract MTV20-DP-002.

10. Russo A, et al. J Headache Pain 2020;21:69.

11. Varnado OJ, et al. J Headache Pain 2021;22(Suppl 1)103:84: Abstract PO218.

12. Hepp Z, et al. Cephalalgia 2015;35:478–88.

13. Hepp Z, et al. Cephalalgia 2017;37:470–85.

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