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Improved migraine management approaches are needed to address current challenges

For people whose migraine frequency or severity impacts daily activities, preventive medication may be an option.1,2 Options for preventive therapy include anti-epileptics, beta blockers, anticonvulsants, anti-hypertensives, and neurotoxins.3-5

Preventive therapy is effective for some patients. Studies indicate that ~45% of patients receiving preventive therapy will experience a reduction in the mean monthly frequency of migraine attacks by ≥ 50%.1,6 Even though there is a potential benefit in using preventive therapy, data suggest that it is underutilized. Results from the American Migraine Prevalence and Prevention (AMPP) study suggest that as many as two thirds of patients who qualify for preventive therapy do not receive it.2

Better identification of appropriate patients is needed to get the right patients on the right management plan for them. Appropriate candidates for preventive therapy should be rapidly identified based on migraine frequency, severity, and impact on their lives.1

Challenges associated with current migraine management

Current preventive therapies may present challenges including poor adherence, adverse events, titration issues, and overall treatment experience.1,7

Approximately 3.5 million patients currently take preventive therapy.8
However, studies show that:


Approximately 80% of patients discontinue oral preventive therapy after 1 year of treatment.7


More than 40% of patients receiving therapy still experience at least one migraine-related issue, including headache-related disability, treatment dissatisfaction, and/or excessive opioid use.9


Up to 13% of patients with migraine receiving acute and/or preventive therapy still have at least 1 emergency department visit a year.10

A standard approach to the initiation and continuation of preventive therapy is key to effective migraine management

Migraine management should be ongoing and should account for multiple factors. Ideal migraine management should identify appropriate patients and measure them based on1,11,12:

  • Frequency of migraine-affected days and severity of migraine pain
  • Frequency of acute medication use
  • Impact of functional pain

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1. D’Amico D, Tepper SJ. Prophylaxis of migraine: general principles and patient acceptance. Neuropsychiatr Dis Treat. 2008;4(6):1155-1167. 2. Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF; for AMPP Advisory Group. Migraine prevalence, disease burden, and the need for preventative therapy. Neurology. 2007;68(5):343-349. 3. Barbanti P, Aurilia C, Egeo G, Fofi L. Future trends in drugs for migraine prophylaxis. Neurol Sci. 2012;33(suppl 1):S137-S140. 4. Estemalik E, Tepper S. Preventive treatment in migraine and the new US guidelines. Neuropsychiatr Dis Treat. 2013;9:709-720. 5. Hepp Z, Bloudek LM, Varon SF. Systematic review of migraine prophylaxis adherence and persistence. J Manag Care Pharm. 2014;20(1):22-33. 6. Silberstein SD, Holland S, Freitag F, Dodick DW, Argoff C, Ashman E; for Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78(17):1337-1345. 7. Hepp Z, Dodick DW, Varon SF, Gillard P, Hansen RN, Devine EB. Adherence to oral migraine-preventive medications among patients with chronic migraine. Cephalalgia. 2015;35(6):478-488. 8. Data on file, Amgen Inc. MarketScan data. March 31, 2017. 9. Lipton RB, Buse DC, Serrano D, Holland S, Reed ML. Examination of unmet treatment needs among persons with episodic migraine: results of the American Migraine Prevalence and Prevention (AMPP) Study. Headache. 2013;53(8):1300-1311. 10. Bonafede M, Cappell K, Kim G, Sapra S, Shah N, Desai P. Healthcare utilization and annual direct costs in patients with migraine in a commercial claims database. J Manag Care Spec Pharm. 2015;21(10-a):S48-S49. 11. Goadsby PJ, Lipton RB, Ferrari MD. Migraine—current understanding and treatment. N Engl J Med. 2002;346(4):257-270. 12. Silberstein SD. Preventive migraine treatment. Continuum. 2015;21(4 Headache):973-989.