Migraine prevention: Towards patient-centric management of chronic migraine

Migraine unmet needs are unchanging

Dr Amaal Starling, Mayo Clinic College of Medicine, identified that in spite of major treatment advances, approaches to care and migraine unmet needs have remained consistent for decades. Patients with frequent attacks, high acute medication use, and worsening disease are especially in need of better management.

A 2021 online survey of 550 US adults currently experiencing high frequency migraine and high acute medication use, identified several areas in which healthcare practitioners can provide better care, including an improved understanding of migraine and a broader awareness of patients’ mental health and wellbeing.¹ Despite recent treatment advances, many people with high frequency migraine are dissatisfied with their care and struggling to achieve their health goals.

“Better migraine prevention will likely lead to improvement in acute treatment optimization.” – Dr Amaal Starling, Mayo Clinic College of Medicine

The cycle of migraine chronification and medication overuse

Medication overuse is part of the cycle of worsening and a risk factor for the transition from episodic to chronic migraine.^2,3 Medication overuse headache (MOH) develops as patients increase the quantity and frequency of their medication usage in order to gain control of their headache disorder.^3,4

Dr Michael J. Marmura, Jefferson Headache Center, explained that MOH can be managed by reducing acute medication use and initiating preventive therapy with treatments of proven efficacy.^5-8 Migraine prevention with an injectable calcitonin gene-related peptide monoclonal antibody is demonstrated to reduce acute headache medication and headache frequency to below diagnostic thresholds in patients with chronic migraine and MOH.⁸

“Preventive therapy for migraine really needs to match the patient’s needs.” Dr Michael J. Marmura, Jefferson Headache Center

Bridging the gap between clinician goals and patient needs

Professor Robert Cowan, Stanford University School of Medicine, considered that understanding patient needs and directly incorporating their input into care plans are important strategies for partnerships that support patient-centric goals. Although this is well understood,⁹ it can be challenging to enact in practice, he added.

While clinicians may have very tangible goals for each patient, patients themselves often have additional needs, and increased understanding of patient preferences for medication attributes will help clinicians better match patients with treatments that align with their preferences. Among 604 US adults with migraine, the three most important attributes of preventive treatment were identified as mode of administration, durability of effectiveness, and speed of onset.¹⁰

“Migraine treatment goals need to be patient-orientated rather than disease-orientated.” Professor Robert Cowan, Stanford University School of Medicine

Towards patient-centric migraine care

Professor Cowan summarized that understanding the patient’s experience, migraine burden, functional impairment, and treatment goals as a basis for shared decision making are especially important when partnering with a patient to initiate or modify an individualized care plan. In addition, taking time to explain the diagnosis with the patient and providing education can help to improve patient engagement and outcomes.

Educational financial support for this Satellite symposium was provided by Lundbeck A/S