woman seeking migraine relief

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

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


A retrospective analysis of a US claims database* found that approximately 70% of patients were non-adherent to oral preventive therapy after 6 months of treatment.7

Migraine is the 5th most common complaint in the emergency department (ED).9,10


In a retrospective analysis of ED patient records, 68% of all migraine-related ED visits result in opioid use.11 

*Retrospective claims analysis of a US claims database (Truven MarketScan Databases) was queried to identify patients who were at least 18 years of age, diagnosed with chronic migraine, and initiated an oral migraine preventive medication (antidepressants, beta blockers, or anticonvulsants) between January 1, 2008, and September 30, 2012 (N = 8,688).7

Among severe headache sufferers who reported use of the ED, people living with migraine (migraine, probable migraine, and transformed migraine) accounted for 95.1% of all ED visits.9

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 on1,12,13:

  • Frequency of migraine-affected days and severe migraine pain
  • Frequency of acute medication use
  • Functional impact of 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 preventive 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. Friedman BW, Serrano D, Reed M, Diamond M, Lipton RB. Use of the emergency department for severe headache. A population-based study. Headache. 2009;49(1):21-30. 10. Centers for Disease Control and Prevention. National Center for Health Statistics. National Hospital Ambulatory Medical Care Survey: 2014 Emergency Department Summary Tables. https://www.cdc.gov/nchs/data/nhamcs/web_tables/2014_ed_web_tables.pdf. Accessed December 14, 2017. 11.Tornabene SV, Deutsch R, Davis DP, Chan TC, Vilke GM. Evaluating the use and timing of opioids for the treatment of migraine headaches in the emergency department. J Emerg Med. 2009;36(4):333-337. 12. Goadsby PJ, Lipton RB, Ferrari MD. Migraine — current understanding and treatment. N Engl J Med. 2002;346(4):257-270. 13. Silberstein SD. Preventive migraine treatment. Continuum (Minneap Minn). 2015;21(4 Headache):973-989.