Experts from the International Headache Society (IHS) have issued an official statement calling for improved standards of migraine care, including more ambitious goals for prevention and treatment in clinical practice. It was published in the journal Cephalalgia.
Migraine is one of the most common neurological diseases, significantly affecting quality of life and productivity. 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 fail to restore quality of life. Furthermore, relying solely on this percentage may mask the persistent impact of the residual disease burden.
Simona Sacco of the University of L'Aquila and other experts from the International Headache Society have proposed introducing more ambitious treatment goals and evaluation criteria. The authors cite 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 quality of life for migraine patients, which, in their opinion, is currently under-recognized.
Experts proposed identifying candidates for preventive therapy based on the number of attack days per month (four or more), significant loss of ability to work and function, frequent use of acute pain medications, and their insufficient effectiveness or intolerance due to side effects. They also set the following goals for preventive therapy across four levels:
Migraine freedom (complete absence of 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 within the first day of treatment in a significant proportion of patients. You can test your knowledge of migraines and, if necessary, expand it with the "Lie down, sleep, and it'll all go away?" quiz.
