Q&A: International Headache Society encourages providers to realign goals of migraine care

Key takeaways:

• A new position statement recommends physicians raise their standards for migraine goals.
• New treatments can improve patients’ quality of life.

The International Headache Society recently issued a position paper that upgraded the standards for migraine prevention, providing a four-pronged framework for reassessing the goals for migraine control and prevention.

The framework is centered on four levels of monthly patient disability: migraine freedom (no days with migraine or moderate to severe headache); optimal control (fewer than 4 days per month); modest control (4 to 6 days per month) and insufficient control (more than 6 days per month).

Healio spoke to paper co-author Teshamae S. Monteith, MD, FAHS, FAAN, chief of the headache division at the University of Miami Miller School of Medicine, to elaborate on the implications of the new guidance, which include greater consideration for overall patient health.

Healio: What factors initiated a review and reworking of International Headache Society standards regarding migraine?

Monteith: The statement was prompted by the recognition that not only is migraine disease highly disabling, underdiagnosed and undertreated, but that there is also a residual burden of disease despite the use of migraine prevention. We aimed to encourage the scientific and health care community to aim for higher standards to maximize the reduction in migraine days as far along the continuum as possible so that there is minimal to no disruption in quality of life and improved function.

Healio: How was the shift from symptom-specific to quality-of-life-specific treatment focus agreed upon?

Monteith: While it is agreed that the symptomatic relief is still an important goal for people living with migraine, higher standards for migraine care includes a focus on optimizing migraine prevention so that there is less residual burden, including interictal symptoms, and anticipatory anxiety that impedes the planning of activities and the ability to live a life with full function.

Healio: How did consensus arrive on the new four-pronged framework for migraine control?

Monteith: The framework was derived to allow for simplicity but comprehensiveness, and with an emphasis on usability in clinical practice, which maximizes positive outcomes. For example, a patient who starts with high frequency episodic migraine occurring 10 days per month but has a 50% response to treatment is still suboptimal. We have defined the threshold for insufficient control at greater than 6 migraine or moderate to severe headache days to prompt action sooner, when disability is likely, and before there is migraine progression.

Healio: Can you specify what benefits in clinical care for patients with migraine that you expect from this new framework?

Monteith: The benefits of this new IHS statement to clinical care include the potential capacity to drive improved quality of life and reduce disability by resetting goals to achieve more optimal care, and even to consider migraine freedom. While this may be somewhat aspirational, we know that we can do better with existing treatments, especially in the era of migraine-specific treatments such as calcitonin-gene related peptide inhibitors that provide better efficacy, tolerability, and may be effective even for people with a history of multiple migraine preventive failures. This may be made possible with a variety of nonpharmacological and pharmacological approaches, based on shared decision-making, digital applications and enhanced communication. The goal is also to encourage scholarly activities and research in this area, so that new targets may be discovered for this complex migraine disease.

Healio: How do you anticipate these higher standards will impact the larger burdens of health care cost and quality of life?

Monteith: Already, we know that there are many patients with migraine who would benefit from migraine prevention but are not getting them while others have suboptimal control. We believe this strategy can work within the existing reimbursement frameworks so that there is minimal impact on the burdens of health care. In addition, better control may result in less costs associated with migraine-related health care utilization, as well as the potential impact on migraine comorbidities that may also be reduced. Research in this area is an investment, and we encourage continued efforts to find new targets for better migraine care. Through education, clinical innovation and improvements in our health care systems, we have an opportunity to reduce the burden of migraine disease. We invite health care providers to become a member of the International Headache Society, and to take advantage of the resources available.

Reference:

Monteith TS, et al. Cephalalgia. 2025;doi:10.1177/03331024251320608.

For more information:

Teshamae S. Monteith, MD, FAHS, FAAN, can be found on LinkedIn here and on X: @headacheMD.