The 2021 American Headache Society Guidelines on the Principles of Preventive Migraine Treatment include:
- using evidence-based treatments
- titrating until clinical benefits are achieved
- giving each treatment a trial of at least 2–3 months
- avoiding overuse of acute treatments
Titration is not necessary with injectable preventive treatments, which are initiated at therapeutic doses and have a relatively rapid onset of action. Furthermore, it states that patients who have severe, disabling, or frequent migraine attacks, as well as those who cannot tolerate or are nonresponsive to acute treatment, should be considered for preventive treatment.
The decision to initiate preventive treatment should be based on:
- the frequency of migraine attacks
- average number of days with migraine
- moderate/severe headache
- degree of disability
What are the key factors that lead you to initiate migraine prophylaxis?
How do CGRPs fit into your treatment algorithm?
Reference:
- Ailani J, et al. (2021) The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache: The Journal of Head and Face Pain 61:1021-1039.
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Katherine Moyer3yrIt may be difficult to trial each treatment for 2-3 months in patients with severe, disabling migraines. Do you give a trial of a preventative treatment and ask patients to Show More -
Huma Sheikh, CEO, NY Neurology Medicine, PC3yrThe key factors in deciding on starting a preventing are number of days of headache and patient disability.
