Experts from the International Headache Society (IHS) have issued a statement calling for higher standards of migraine care, with more serious goals for prevention and treatment applied in clinical practice. It is published in the journal Cephalalgia.
Migraine is one of the most common neurological diseases, with significant impact on quality of life and ability to work. This results in significant social and economic losses. Current treatment standards, which aim to reduce the number of attack days by 50 percent or more, may not restore quality of life. However, relying on such percentages alone may mask the persistent impact of residual disease burden.
Simona Sacco from the University of L'Aquila and other experts from the International Headache Society have proposed introducing more ambitious treatment goals and criteria for its evaluation. The authors believe that this is based on the recent emergence of new preventive and therapeutic methods (for example, the use of CGRP inhibitors, or hepants, and onabotulinumtoxinA), as well as the need to restore the quality of life of migraine patients, which, in their opinion, is currently not given enough attention.
The experts suggested identifying candidates for preventive therapy based on the number of attack days per month (four or more), significant loss of ability to work and functionality, frequent use of acute pain medications, and their insufficient effect or intolerance due to side effects. They also set the following goals for preventive therapy at four levels:
Migraine freedom (no days with moderate or severe headache) is the primary but rarely achievable goal;
optimal control (less than four days with moderate or severe headache per month for three months and a good response to relievers) is a goal that exceeds current clinical guidelines;
limited control (four to six days with moderate or severe headache per month) does not exclude intermittent disability but may be a goal for frequent or persistent migraine (10–14 or more days with attacks per month);
inadequate control (more than six days with moderate or severe headache per month) indicates inadequate therapy.
Previous clinical trials have shown that prophylactic and therapeutic use of the CGRP receptor antagonist atogepant eliminates migraine headaches on the first day of use in a significant proportion of patients. You can test your knowledge of migraine and, if necessary, expand it in the test "Lie down, sleep, and everything will go away?"
