Migraine Briefs

Guidelines on Integrating New Migraine Treatments

Headache; ePub 2018 Dec 10; American Headache Society


In order to provide healthcare professionals with updated guidance in the use of novel preventive and acute treatments for migraine in adults, a recent position statement released by the American Headache Society updates prior recommendations and outlines the indications for initiating, continuing, combining, and switching preventive and acute treatments. Input was sought from health insurance providers, employers, pharmacy benefit service companies, device manufacturers, pharmaceutical and biotechnology companies, patients, and patient advocates. In addition, expert clinicians and researchers in the field of headache medicine from across North America and the European Union provided input and feedback.

The principles of pharmacologic preventive treatment of migraine with oral treatments have been as follows:

  • Use evidence‐based treatments when possible and appropriate.
  • Start with a low dose and titrate slowly; newer injectable treatments may work faster and may not need titration.
  • Reach a therapeutic dose if possible.
  • Allow for an adequate treatment trial duration.
  • Establish expectations of therapeutic response and adverse events and maximize adherence.

The principles of acute treatment include:

  • Use evidence‐based treatments when possible and appropriate.
  • Treat early after the onset of a migraine attack.
  • Choose a non-oral route of administration for selected patients.
  • Account for tolerability and safety issues.
  • Consider self‐administered rescue treatments.
  • Avoid overuse of acute medications.

American Headache Society. The American Headache Society position statement on integrating new migraine treatments into clinical practice. [Published online ahead of print December 10, 2018]. Headache. doi:10.1111/head.13456.

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