TY - JOUR
T1 - Redefining Expectations for Migraine Prevention
AU - Cady, Roger
AU - Gottschalk, Christopher
AU - Pavlovic, Jelena
N1 - Publisher Copyright:
© Touch Medical Media 2021.
PY - 2021
Y1 - 2021
N2 - With the advent of new preventive migraine treatments, such as calcitonin gene-related peptide inhibitor monoclonal antibodies, there is a need to ensure realistic treatment expectations, and to carefully consider therapeutic options. Current treatment guidelines suggest that reductions in mean monthly headache days of ≥50% from baseline should be considered evidence of treatment efficacy, although in some patients, benefits can be seen at lower thresholds. However, patients may expect greater reductions in migraine attacks, so setting realistic expectations is important for treatment success. As treatment side effects and a lack of efficacy are the main reasons for treatment discontinuation, possible side effects should be discussed, and the individual goals of patients considered. Current American Headache Society guidelines suggest candidacy for preventive migraine treatment is primarily based on the frequency of attacks in the USA, with treatment recommended for patients who have ≥4 migraine days per month. However, even fewer than 4 monthly headache days per month can have a severe impact on overall health-related quality of life in addition to impairment during individual episodes. Finally, the use of acute therapy should be carefully monitored and considered when treatment decisions are being made, to ensure optimization of use, and to avoid overuse and progression to chronic migraine. These considerations indicate that patient needs are multifaceted and that management decisions need to be crafted on a case-by-case basis.
AB - With the advent of new preventive migraine treatments, such as calcitonin gene-related peptide inhibitor monoclonal antibodies, there is a need to ensure realistic treatment expectations, and to carefully consider therapeutic options. Current treatment guidelines suggest that reductions in mean monthly headache days of ≥50% from baseline should be considered evidence of treatment efficacy, although in some patients, benefits can be seen at lower thresholds. However, patients may expect greater reductions in migraine attacks, so setting realistic expectations is important for treatment success. As treatment side effects and a lack of efficacy are the main reasons for treatment discontinuation, possible side effects should be discussed, and the individual goals of patients considered. Current American Headache Society guidelines suggest candidacy for preventive migraine treatment is primarily based on the frequency of attacks in the USA, with treatment recommended for patients who have ≥4 migraine days per month. However, even fewer than 4 monthly headache days per month can have a severe impact on overall health-related quality of life in addition to impairment during individual episodes. Finally, the use of acute therapy should be carefully monitored and considered when treatment decisions are being made, to ensure optimization of use, and to avoid overuse and progression to chronic migraine. These considerations indicate that patient needs are multifaceted and that management decisions need to be crafted on a case-by-case basis.
KW - Migraine
KW - health-related quality of life
KW - treatment
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U2 - 10.17925/USN.2021.17.Suppl.1.2
DO - 10.17925/USN.2021.17.Suppl.1.2
M3 - Article
AN - SCOPUS:85169316254
SN - 1758-4000
VL - 17
SP - 2
EP - 7
JO - touchREVIEWS in Neurology
JF - touchREVIEWS in Neurology
ER -