New treatments and management strategies for migraine

New treatment and management strategies for migraine include calcitonin gene‐related peptide (CGRP) antibodies, layered therapy, and innovative telemedicine protocols. They and were discussed by several presenters at the Virtual Scottsdale Headache Symposium 2020.

Calcitonin gene‐related peptide (CGRP) antibodies

The AHS position statement provides criteria for use of antiCGRP antibodies

Since the approval of antiCGRP antibodies for migraine by the US Food and Drug Administration in 2019,1 the American Headache Society (AHS) has released a position statement on their use,2 said Professor Jack Schim, The Headache Center of Southern California, CA.

AntiCGRP antibodies can be prescribed by a licensed medical provider to patients ≥18 years of age if the migraine fulfils one of the following:

  • International Classification of Headache Disorders, 3rd edition (ICHD-3) migraine with or without aura3 + 4–7 monthly headache days (MHD) + failure to respond to or inability to tolerate at least two Level A or B migraine preventive therapies4 + at least moderate disability
  • ICHD-3 migraine with or without aura + 8–14 MHD + failure to respond to or inability to tolerate at least two Level A or B migraine preventive therapies
  • ICHD-3 chronic migraine + failure to respond to or inability to tolerate:
    • at least two Level A or B migraine preventive therapies, or
    • at least two quarterly injections (6 months) of onabotulinumtoxinA1

Wear-off leads to worsening of migraine symptoms before the next dose

Dr Maria Garcia-Ayala, Hartford Healthcare Headache Center, CT, noted that patients receiving antiCGRP antibodies may experience wear-off and might perceive worsening of migraine symptoms before receiving their next dose. She is therefore evaluating the rate, associated factors, and treatment group characteristics associated with the wear-off.5

 

Layered therapy

Lifestyle and complementary therapies (read more here) are often layered with pharmacologic therapy, despite limited evidence on the use of layered therapy, said Professor Schim.

Mindfulness improves migraine management self-efficacy

Some of the techniques, such as mindfulness, may improve self-efficacy, which is an individual’s belief in their ability to manage a migraine attack, said Dr Nicole Butler, Ferkauf Graduate School of Psychology, New York.

She presented her analysis of a Phase 2b Mindfulness-Based Cognitive Therapy for Migraine (MBCT-M) trial. MBCT-M significantly improved migraine management self-efficacy over time. Additionally, self-efficacy mediated changes in time on disability.6

 

Innovative telemedicine for safety-net populations

A structured script to drive ownership of diagnosis and treatment

Telemedicine can improve access to care for patients who are unable to attend the clinic, said Dr Daniel Oh, Los Angeles County and University of Southern California Medical Center, CA.

He described an innovative procedure he is evaluating for patients receiving telemedicine. A ‘Tell-a-doc’ instruction sheet on check-in guides patients in initiating the conversation by describing details of their headache and treatment regimen.7 It is hypothesized that this will improve outcomes, said Dr Oh.

 

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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. US Food and Drug Administration. Available at: https://www.fda.gov/drugs/news-events-human-drugs/new-drug-class-employs-novel-mechanism-migraine-treatment-and-prevention Accessed 24 Dec 20.
  2. American Headache Society. Headache 2019;59:1–18. 
  3. Classification Committee of The International Headach Society. Cephalalgia 2018;1:1–211.
  4. Silberstein SD, et al. Neurology 2012;78:1337–45.
  5. Garcia-Ayala ME. Calcitonin gene-related peptide monoclonal antibody wear-off phenomenon in the treatment of migraine. 2020. Poster presented at the AHS Scottsdale Meeting virtually on Nov 21, 2020.
  6. Butler N. MindfuIness-based cognitive therapy and self-efficacy in people with migraine. 2020. Presented at the AHS Scottsdale Meeting virtually on Nov 21, 2020.
  7. Oh D. Tell-a-doc: Improving access to migraine care in safety-net populations with alternative methods of clinical care during the COVID-19 pandemic. 2020. Poster presented at the AHS Scottsdale Meeting virtually on Nov 21, 2020.
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