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

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.