New Migraine Consensus Focuses on Prevention
Belden, Heidi, Drug Topics
Migraines are now viewed as a chronic disorder with episodic manifestations, and emphasis should be put on evaluating impairment between headache attacks. This is the gist of a new consensus statement recently released by the National Headache Foundation (NHF), an organization focusing on migraine prevention.
"In the past, migraine was considered an episodic disorder and treated with acute abortive medications such as the triptans. However, in recent years, new scientific data and epidemiological research have led to a new paradigm shift in migraine treatment," said Jackie Kwong, Pharm.D., Ph.D., assistant professor at the University of Georgia College of Pharmacy.
Imaging studies have suggested that migraine may lead to progressive brain changes, and an epidemiology study has found that some patients suffering from episodic migraine may progress to chronic daily headache, Kwong explained. "Therefore, there is an interest in shifting the focus from aborting migraine attacks after they've occurred to preventing them from happening at all."
Despite recent studies showing that migraine may progress as a dis ease in some patients and that there is a real need for preventive treatment options, other research, such as the American Migraine Prevalence and Prevention (AMPP) study, found that nearly 40% of patients may benefit from preventive therapy but that only 13% are using a preventive medication. Almost half of the patients weren't even aware that preventive treatment options existed.
The American Migraine Communications Study (AMCS) found that only 10% of patient visits to their physician involved discussion of migraine impairment. This study concluded that clinicians need to ask patients "open-ended" questions.
Specifically, the NHF Migraine Prevention Summit Consensus Statement states that acute medication is not always adequate to control migraine attacks. In an effort to minimize the frequency and intensity of migraine, NHF recommends initiating preventive therapy if headaches occur two or more times per month with disability on three or more days per month mat significantly interferes with daily routines. Preventive treatment should also be instituted if the patient is using acute medication more than twice per week, or if acute therapies are contraindicated, not tolerated, or are ineffective. …