ELEVATE PREVENTIVE MIGRAINE MANAGEMENT
How do you know if your patient is doing well on their preventive treatment?
Learn more about how to assess whether your patients are optimized, and the recommendations for first-line approaches to prevention.
Stop the cycle
50% of patients, the majority of whom were on nonspecific migraine preventives, still met the criteria for needing a preventive treatment, suggesting inadequate benefit from their current regimen.1
Migraine patients who have cycled through more than one preventive treatment may encounter higher rates of the following:
Discontinuing or switching two or more classes of preventive treatment (including nonspecific migraine preventives) significantly increases total direct healthcare costs.2
Migraine patients requiring more drug-class switches appeared to have increased use of acute medications, with opioid use being the highest. 2
Among individuals with migraine who have taken more than one preventive treatment, 76% are exhausted with the cycle of hoping for success followed by failure.3
What to ask your patients before starting a migraine preventive treatment
Explore ways to individualize migraine prevention for your patients with Dr. Nate Bennett.
Hi, Iʼm Dr. Nate Bennett, Board-Certified Family Physician and Headache Specialist.
Did you know there are now more choices for migraine prevention than ever before, yet preventive therapy remains underutilized?
When preventive treatment isnʼt tailored to individual needs or preferences, patients may discontinue and be more hesitant to start new treatments.
Here are three examples of questions you can ask to help ensure your patients start and stay on the right preventive for them.
What route of administration does the patient prefer? Some patients may prefer an injection they can take less frequently, while others may prefer oral medications.
Since the length of time that injectables and orals can take to leave the body varies, consider if the flexibility to start and/or stop treatment due to family planning or sensitivity to adverse events is important for them.
What comorbidities does the patient have? Some migraine preventives were originally developed for other diseases, which can be appropriate for patients with certain comorbidities, but could be inappropriate with others.
The approach of using one drug to treat two diseases may lead to undertreating both. Consider the use of migraine-specific preventives like CGRP targeting treatments for those who may not be optimized with this approach.
What potential side effects might impact their quality of life? Tolerability is a major factor in patient adherence, and certain side effects can impact patient quality of life by interfering with daily activities.
For example, certain preventives may cause side effects that can impact patients who need to concentrate or think clearly as part of their daily tasks.
Consider asking questions like these to help match patients to the right migraine preventive to improve adherence, satisfaction and health outcomes.
Dr. Nate Bennett
Dr. Nate Bennett is a paid consultant of AbbVie.American Headache Society's goals for preventive therapy 4
Improve
Reduce
What to consider for your patients on prevention
Watch Dr. Hope O’Brien discuss the importance of migraine prevention and treatment optimization for healthcare providers.
Did you know?
Migraine can be a progressive disease, meaning it may worsen over time if not adequately treated. And one of the strongest risk factors for progression is a higher frequency of monthly headache days.
This can be concerning, because we know higher monthly headache days may mean more disability for patients.
Thankfully, preventive therapy can help reduce both monthly migraine days and disability.
Hi, I’m Dr. Hope O’Brien, Founder and CEO of Headache Center of Hope and a paid consultant of AbbVie.
Did you know the American Headache Society now recommends migraine-specific treatments, such as CGRP antagonists, as a first line option for prevention?
We know so much more about what is happening in the brain during the migraine attack now than we did decades ago when all that was available for prevention were treatments originally developed for other diseases.
Migraine-specific treatments, on the other hand, were both designed and approved for migraine.
CGRP antagonists are migraine-specific treatments that target an inflammatory neuropeptide we now know has an established role in the pathophysiology of the disease.
There is robust evidence for migraine-specific preventive treatments, including efficacy and safety across both episodic and chronic migraine.
These trials also support efficacy beyond migraine day reduction through a newfound emphasis on patient reported outcomes, function, and quality of life.
For example, most migraine-specific treatment options have data on:
- The ability to perform daily activities
- Interictal burden
- Non-headache symptoms like the ability to concentrate or think clearly
The reason I get excited about these data is that they more closely resemble clinical practice. When I talk to my patients, I make sure to ask: “How is migraine still impacting your life?”
And based on their response, that helps inform when my patient and I may need to have a conversation about optimizing their preventive treatment.
So talk to your patients about how they are doing on their migraine preventive. And if you haven’t checked it out yet, read the AHS Position Statement, and consider migraine-specific therapies as a first line option.
Dr. Hope O'Brien
Dr. Hope O'Brien is a paid consultant of AbbVie.How are you assessing how migraine
impacts your patients’ lives?
Patient-reported outcomes (PRO) domains6,7
Patient conversations should address how migraine impacts important life domains.
Leisure
activities
Living with migraine may mean canceling plans.6
Relationships
& social activities
People living with migraine reported that if they did not have headaches, they would be a better partner…6
Home activities,
errands & chores
…and if they did not have headaches, they would be a better parent.6
Tiredness
& energy levels
People with migraine report that migraine robs them of energy…7
Concentration
& clear thinking
…and interferes with their ability to think clearly or focus on daily activities and tasks.7
Physical activity,
body movement
A majority of people with migraine stated assistance was required for physical aspects of life.7
Work activities &
productivity
Living with migraine could mean missing work.7
Migraine can disrupt many facets of daily life.
How are you checking in?
Take a look through this guide for considerations that can enable
you to have meaningful discussions with patients about their overall well-being.
Function discussion guide8
Why does function matter?
Watch Dr. Christopher Gottschalk discuss the functional impairments that can impact migraine patients.
Hello, I’m Dr. Christopher Gottschalk.
I’m a board-certified neurologist and headache specialist, and President of the Alliance for Headache Disorders Advocacy, AHDA.
Migraine is one of the most common diseases in the world, affecting about 1 billion people worldwide. But did you know, according to the Global Burden of Disease study, migraine is the leading cause of disability in people under 50 years of age?
In fact, migraine causes more years lived with disability than all other neurological disorders combined.
Reduction in migraine days is typically used as an important primary endpoint, although this endpoint does not capture what matters most to patients and providers: quality of life.
Now, let’s look at data from the CaMEO analysis which shows:
- 1 out of 3 have had their careers impacted by migraine
- Almost 40% feel they would be a better parent if they did not have migraine
- Nearly half feel they would be a better partner if they did not have headaches
Recent trials have begun to assess the impact of preventive therapy on validated patient-reported outcome measures, PROMS, assessing migraine-related quality of life. Such as:
- MSQ
- MIDAS
And countless others. Now, healthcare providers can focus on choosing the preventive therapy that may improve the everyday well-being of their patients. As healthcare providers, we can shift the dialogue with our patients and focus on:
- How migraine impacts important PRO domains like: Home, Activities, Energy Levels, Concentration & clear thinking, Physical Activity, Work Activity, and Social Activities
- Discussing how early and significantly treatment can impact quality of life, using at least one of these PRO domains in a post-treatment follow-up discussion and asking the question: What have you been able to do that you couldn’t do before you started this treatment?
To recap, migraine is not just a numbers game: the true goal is to improve a person’s overall quality of life. Patient Reported Outcomes are the future of migraine research, and the increased focus on functional outcomes has the potential to dramatically impact treatment decisions and improve provider and patient understanding.
Dr. Christopher Gottschalk
Dr. Christopher Gottschalk is a paid consultant of AbbVie.References
1. Buse DC et al. Headache. 2024;64(5):469-481.
2. Ford JH et al.
J Manag Care Spec Pharm. 2019;25(1):46-59. 3.
National Headache Foundation. Preventing migraine attacks: a current perspective.
https://headaches.org/wp-content/uploads/2021/05/NHF-Preventing-Migraine-Attacks-Report-Updated-Reference-2021MAY10.pdf
4. Ailani J et al. AHC Consensus Statement. Headache. 2021;61:1021-1039.
5. Buse DC, et al. Headache. 2019;59(8):1286-1299.
6. Data from My Migraine Voice survey: an online, global survey of people living with migraine (N=11,266)
Martelletti P, et al. J Headache Pain. 2018;19(1):115.
7. Charles AC et al. Headache. 2024;64(4):333-341.
8. AbbVie. AGPT-US-00104-FM (2024). AbbVie. AGPT-US-00104-FM (2024). Migraine can disrupt many facets of daily
life: How are you checking in? [Patient education guide].
