What can be done to improve outcomes for patients with migraine? Patients who have a poor response to acute treatment have an increased risk of progression to chronic migraine. The unmet needs of these patients were presented in a satellite symposium at AAN 2021, while treatment gaps in the use of preventive therapy were highlighted in a poster.
Which patients with acute migraine are most likely to develop chronic migraine?
Patients with episodic migraine who have a poor response to acute treatment are more likely to develop chronic migraine, said Dr Kathleen Mullin, Stanford, CT.
Patients with a very poor response to acute treatment have a three-fold increased risk of developing chronic migraine over 1 year
The risk of developing chronic migraine over 1 year is three times higher for patients with a “very poor response efficacy” compared to that for patients who experience “maximum treatment efficacy”.1
Acute treatment unmet needs
A poor response to traditional acute treatments is associated with unmet needs in the management of acute migraine, explained Dr Mullin, and include:
Medication overuse headache is common and results from overuse of acute therapies
- Inadequate migraine relief—reported by up to 56% of 8233 eligible respondents in the American Migraine Prevalence and Prevention Study2
- Adverse events—experienced by 43% of 37,250 patients evaluated in a Cochrane review oral triptans3
- Recurrence of migraine after initial relief within 24 hours in between 17 and 40% of patients depending on the triptan used4
- Cardiovascular contraindications to the many vasoconstrictive acute migraine medications—it has been estimated that this impacts approximately 2.6 million people with episodic migraine in the US5
- Medication overuse headache, which is a common consequence of overuse of many prescription and over-the-counter acute therapies6
Preventive treatment gaps
Consider preventive treatment for patients with migraine who have four or more headache days/month
Preventive treatment should be considered for people with migraine who have four or more headache days/month according to the 2019 American Headache Society Position statement on integrating new migraine treatments into clinical practice.7
An evaluation of the actual use of oral preventives by respondents to the web-based survey Chronic Migraine Epidemiology and Outcomes (CaMEO) Study in 2012 and 2013 was presented in a poster by Nahas et al.8
Among the 16,789 respondents in the CaMEO Study, 39% had four or more headache days/month so were potentially eligible for preventive therapy.
80.2% of preventive-eligible respondents had never used preventive therapy
Among these 6579 preventive-eligible respondents:
- 80.2% had never used a preventive treatment, with 64.7% of these respondents reporting moderate-to-severe headache-related disability
- <10% were using an oral preventive therapy
- 50.8% of those who had ever used an oral preventive had discontinued use, and discontinuations were mainly attributed to safety, tolerability, and efficacy concerns8
The satellite symposium was sponsored by Biohaven Pharmaceuticals.
The CaMEO study was sponsored by Allergan prior to its acquisition by AbbVie, and the poster was funded by AbbVie.
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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.
