Acute Treatment of Migraine: Expert Consensus Statements from the United Arab Emirates (UAE)

Abstract

Introduction Migraine, characterized by recurrent headaches and often accompanied by other symptoms like nausea, vomiting, and sensitivity to light and sound, significantly impacts patients’ quality of life (QoL) and daily functioning. The global burden of migraines is reflected not only in terms of reduced QoL but also in the form of increased healthcare costs and missed work or school days. While UAE (United Arab Emirates)-specific consensus-based recommendations for the effective use of preventive calcitonin gene-related peptide (CGRP)-based migraine therapies have been published previously, an absence of such regional guidance on the management of acute migraine represents a gap that needs to be urgently addressed. Methods A task force of eight neurologists from the UAE with expertise in migraine management conducted a comprehensive literature search and developed a set of expert statements on the management of acute migraine that were specific to the UAE context. To ensure diverse perspectives are considered, a Delphi panel comprising 16 neurologists plus the task force members was set up. Consensus was achieved using a modified Delphi survey method. Consensus was predefined as a median rating of 7 or higher without discordance (if > 25% of the Delphi panelists rate an expert statement as 3 or lower on the Likert scale). Expert statements achieving consensus were adopted. Results The Modified Delphi method was used successfully to achieve consensus on all nine expert statements drafted by the task force. These consensus statements aim to provide a comprehensive guide for UAE healthcare professionals in treating acute migraine. The statements cover all aspects of acute migraine treatment, including what goals to set, the timing of treatment, treatment strategy to use in case of inadequate response to triptans, safety aspects of combining gepants for acute attacks with preventive CGRP-based therapies, special population (pregnant and pediatric patients) considerations, and the management of the most bothersome symptoms (MBS). Conclusions Adopting these consensus statements on the treatment of acute migraine can help enhance patient care, improve outcomes, and standardize treatment practices in the UAE. The collaborative effort of experts with diverse experiences in developing these consensus statements will strengthen the credibility and applicability of these statements to various healthcare settings in the country.

Effectiveness of Switching CGRP Monoclonal Antibodies in Non-Responder Patients in the UAE: A Retrospective Study

“…Switching was mainly due to lack of efficacy; it was ensured that patients included in the analysis completed at least 3 months of treatment before switching. Evaluating efficacy after a minimum of 3 consecutive months of treatment was adopted based on the EHF and our local guidelines [21,22]. During each phase, patients' MMDs were assessed at 3 stages prior to and following their medication switch: at least one month before the first injection (baseline), at a 3-month follow-up, and at a 6-month follow-up.…”

“…Following the post-switch baseline assessment, mean MMDs dropped to 5.74 (4.32) by month 3 and further decreased to 5.42 (4.98) by month 6. Patients began treatment on CGRP mAbs, as suggested by our local UAE guidelines, based on at least 4 MMDs, or fewer if the attacks were severe or disabling based on the Migraine Disability Assessment (MIDAS) or Headache Impact Test-6 (HIT-6) scores [22]. There was a minimum of a 3-month washout period prior to switching.…”