Unmet Needs in Preventive Treatment of Migraine

Abstract

Migraine represents the most common cause of work disability in young women and the second one in the general population. Preventive treatment can reduce the frequency of attacks and their intensity, consequently improving the quality of life. Despite this, global health systems have shown important gaps in addressing optimal management of preventive therapy. Despite numerous adverse effects of traditional medications for migraine prevention being well known, these medications continue to be considered the standard of care for prophylaxis of this disease in many contexts. On the other hand, the widespread use of calcitonin gene-related peptide (CGRP) receptor antagonists, which have marked a breakthrough in prophylactic therapy of migraine, has been limited because of their high cost. We also highlight important shortcomings in migraine management by general practitioners (GPs) and poor patient education on the disease with a consequent delay in referring selected patients to dedicated headache centres. Over the next few years, we expect the headache medicine community to mobilize to address these gaps in preventive treatment of migraine.

Burden and Unmet Needs in Migraine Patients: Results from the OVERCOME (Spain) Study

“…Reducing headache frequency and severity also has the potential to lessen the broader impacts of migraine on patients’ daily lives, including quality of life, mental health, and the ability to work, study, and socialize [ 22 , 23 ]. Accordingly, a recent study has called for improved consistency in the definitions of terms regarding migraine-related burden, impact, disability, and quality of life [ 22 ].…”

Trends and prescribing patterns of antimigraine medicines in nine major cities in China from 2018 to 2022: a retrospective prescription analysis

“…Limited data from comparative trials suggest that topiramate may have a modest advantage over valproate for episodic migraine prevention [ 25 ]. Adverse events associated with topiramate therapy include depression and weight loss, generally mild to moderate in severity [ 27 , 28 ]. Its evidenced efficacy and favorable safety profile may be the major reasons for its increasing use.…”

“…During the study period from 2018 to 2022, the medications used for acute migraine and migraine prevention were traditional medicines. The newer groups of medicines that target 5HT1F receptor and calcitonin gene-related peptide (CGRP) molecule and receptor have been recently approved and marketed in various countries [ 28 , 32 ]. Rimegepant, a CGRP antagonist, was approved for acute migraine treatment in China in 2024, and anti-CGRP(R) monoclonal antibodies, erenumab and galcanezumab, were approved for migraine prevention in China in 2023 and 2024.…”

Verification of a clinical decision support system for the diagnosis of headache disorders based on patient–computer interactions: a multi-center study

“…In fact, the objective difficulty in the management of primary headaches is the enormity of the number of patients requiring a diagnosis. However, there was important shortcomings in migraine management by general practitioners with a consequent delay in referring selected patients to dedicated headache centers [ 22 ]. Moreover, the delay in diagnosis encourages chronicity and medication overuse as a consequence of the misuse of analgesics, which further increased the burden of headache disease.…”