Return to operate, ache discount main objectives of acute migraine remedy

October 05, 2022

2 min learn


Diamond M. Diamond Headache Clinic migraine monitor: Acute remedy. Offered at: BRAINWeek; Sept. 28-30, 2022; Las Vegas.

Diamond stories monetary relationships with AbbVie/Allergan, Amgen, Assertio Therapeutics, Axsome Therapeutics, BioDelivery Sciences Worldwide Inc., Biohaven Prescription drugs Inc., Eli Lilly & Co., Impel Neuropharma, Lundbeck Prescription drugs, Supernus Prescription drugs, Teva Pharmaceutical Industries and Upsher-Smith Laboratories.

LAS VEGAS — Speedy discount of signs and ache, achieved via the best drug and nondrug therapies, is a key precedence for sufferers who expertise acute migraines, in response to a presenter at BRAINWeek 2022.

“Crucial factor for sufferers is a return to operate,” Merle Diamond, MD, of the Diamond Headache Clinic, stated throughout her presentation. “A very good rule of thumb once I speak to my sufferers about acute remedy … is what share of the time do you assume this drugs works for you? And if a affected person says 50%, it’s not an incredible acute drugs.”

Photo of man with head in hands
Supply: Adobe Inventory.

For acute remedy, versus prevention, there’s much less discord between affected person and doctor relating to remedy objectives, Diamond said. Sufferers with acute migraines require remedy that works, at minimal, 80% to 90% of the time, and 90% of sufferers take oral therapeutics however must assault their migraine ache earlier within the cycle to attain speedy onset of ache freedom. That, Diamond added, requires medicines with established efficacy to be useful in each the brief and long run.

In response to Diamond, NSAIDs, resembling ibuprofen and naproxen, are the primary line of protection for acute migraines. Subsequent are mixture analgesics, resembling acetaminophen with aspirin and caffeine, then triptans (almotriptan, eletriptan, zolmitriptan) in various doses, ergotamine derivatives (dihydroergotamine nasal spray), gepants (rimegepant, Ubrelvy [ubrogepant, AbbVie]) and Reyvow (lasmiditan, Eli Lilly and Co.).

Diamond cited the Nationwide Headache Basis’s (NHF’s) modified step-care mannequin for acute migraine treatment, which seeks to optimize time to pain-free and useful standing and states {that a} affected person must have skilled average to extreme ache associated to migraines and to have “tried and been failed by” two generic medicine earlier than a doctor can prescribe next-level therapies.

Per NHF pointers, a “failed” remedy consists of not less than one of many following: the affected person isn’t migraine pain-free and useful inside 2 hours of remedy after the vast majority of assaults or the affected person has recurrence of migraine signs inside 24 hours after remedy; the affected person can not tolerate the drug because of its uncomfortable side effects; the affected person has a recorded historical past of the drug being proved ineffective or insupportable; or the affected person has a comorbidity and/or different contraindication that precludes the clinician from prescribing the drug.

Widespread difficulties related to acute therapies are underdosing, delayed dose supply and failure to incorporate cooperative brokers with triptans, Diamond stated. An related miscue, she famous, is that sufferers usually attempt to regulate dosage based mostly on time and severity of migraine signs.

“There’s no medical worth to the notion that in the event you attempt one thing at a special dose, both greater or decrease, that there’s no threat of one thing [bad] taking place,” Diamond said.

Nonetheless, there isn’t any rule towards combining sure therapies to attain most effectiveness, she continued.

One of many newer therapies to deal with acute migraine signs is neuromodulation, which may be carried out in a number of methods: supraorbital transcutaneous nerve stimulation, vagal nerve stimulation and single pulse transcranial nerve stimulation.

These choices, in response to Diamond, ought to be thought of after a number of conventional medicine and newer therapies have failed, in circumstances of overuse of normal therapies, in adults preferring nondrug therapies and in pediatric sufferers.

None of those choices, Diamond stated, can actually be of service except sufferers are diligent in preserving an in depth, constant and continuous headache diary. By doing so, sufferers and clinicians can have a transparent image of signs and may enact an efficient, rapid and versatile remedy plan.

“I feel it’s tremendous supportive to listen to the affected person once they say they’re doing effectively,” Diamond stated.


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