What are the unmet needs and treatment gaps for patients with migraine?

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.

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.

  1. Lipton RB, et al. Ineffective acute treatment of episodic migraine is associated with new-onset chronic migraine. Neurology. 2015;84:688–95.
  2. Lipton RB, et al. Predicting inadequate response to acute migraine medication: Results from the American Migraine Prevalence and Prevention (AMPP) Study. Headache 2016;56:1635–48.
  3. Derry CJ, et al. Sumatriptan (oral route of administration) for acute migraine attacks in adults. Cochrane Database of Systematic Reviews. 2012;doi.org/10.1002/14651858.CD008615.pub2.
  4. Geraud G, et al. Migraine headache recurrence: relationship to clinical, pharmacological, and pharmacokinetic properties of triptans. Headache 2003;43:376–88.
  5. Buse DC, et al. Cardiovascular events, conditions, and procedures among people with episodic migraine in the us population: results from the American Migraine Prevalence and Prevention (AMPP) Study. Headache 2017;57:31–44.
  6. Schwedt TJ, et al. Factors associated with acute medication overuse in people with migraine: results from the 2017 migraine in America symptoms and treatment (MAST) study. Headache. 2018;19:38. doi.org/10.1186/s10194-018-0865-z.
  7. American Headache Society Consensus Statement. The American Headache Society Position statement on integrating new migraine treatments into clinical practice. Headache. 2019;59:1–8.
  8. Nahas SJ, et al. Characterizing preventive treatment gaps in migraine: Results from the CaMEO Study. Poster presented at virtual AAN, 17–22 April 2021, abstract no 1514 in Neurology. 2021;96(15 Supplement).
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