Getting a head start on Migraine Prevention

Why is prevention important?

Professor Dawn Buse (Albert Einstein College of Medicine, New York, USA) began by explaining how inadequate treatment of migraines may have long-term implications on pathophysiology and clinical symptoms and outcomes^1,2. This can result in:

Inadequate treatment of migraines may have long-term implications on pathophysiology and clinical outcomes

• Worsening of migraine frequency¹
• Increased severity of symptoms^2,3
• Increased acute medication use and reduced overall effectiveness of medications^4,5
• Increases in disability and comorbidities, and decreased health-related quality of life⁶

Increased disease severity may correlate with structural brain alterations⁷, and alterations in neuropeptide levels⁸ and neuronal activation and function⁹.

One study of the relative importance to patients of different outcomes from a potential new treatment showed that, after ‘take away the headache’, factors weighted most highly were preventive goals of ‘prevent the attack from carrying through’ and ‘make sure no other attack follows’¹⁰.

What should be considered?

Intervening early to prevent or reduce long-term consequences is an important component of effective migraine management

Intervening early to prevent or reduce long-term consequences is therefore an important component of effective migraine management explained Prof Buse. This should be individualized to the particular patient, if possible, as each will come with their own specific migraine and medical history.

Comorbidities are common, with anxiety, depression, chronic pain, arthritis, hypertension, hypercholesterolaemia, and allergies each reported by over a third of patients with migraine¹¹. Comorbidities may be important in the transition from episodic to chronic migraine¹², as is medication overuse headache¹².

What are the goals?

The AHS put together a Consensus Statement in 2021¹³ listing key overall treatment goals to be considered in migraine prevention, including:

• Reduce attack frequency, severity, duration, and severity
• Reduce reliance on poorly tolerated, ineffective, or unwanted acute treatment
• Enable patients to manage their disease to enhance a sense of personal control

There is a continuing need to bridge the gap between healthcare professionals’ goals and the patient’s needs, as they may differ¹⁴.

What treatments are available?

Prevention of migraine attacks requires a personalized long-term multi-pronged approach. This should include non-pharmacological, lifestyle and educational components as well as pharmacological agents. The AHS Consensus Statement¹³ offers a helpful algorithm to aid discussions with patients. Preventive drug treatment can be considered or offered depending on number of headache days/month and degree of associated disability.

Prevention of migraine attacks requires a personalized long-term multi-pronged approach

Dr Jessica Ailani (Georgetown University, Washington DC, USA) and Dr Paul Winner (Nova Southeastern University, Ft. Lauderdale, USA) discussed results from recent clinical trials using CGRP-targeted therapies in migraine prevention¹⁵, including benefits of initiating preventive treatment during the acute attack¹⁶.

How is success measured?

Patient involvement allows specific goal-setting using patient-based assessments of headache impact

Prof Buse described how ‘treat to target’ is an important concept in any migraine prevention plan. Patient involvement in all decision making allows specific goal-setting using patient-based assessments of headache impact¹⁷. Targets are then assessed frequently by both patient and clinician to monitor progress, and treatments regularly adjusted if the target is not reached. This ensures that the individual patient’s self-report of the presence, severity, frequency, and impact of their headache is the basis for assessing the effectiveness of any therapeutic intervention¹⁷.

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