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Many PCPs unfamiliar with effective migraine treatments

SAN FRANCISCO — A variety of treatment options have been shown to be safe and effective options to manage symptoms in headache disorders, which can help to reduce the frequency of migraine attacks.

Depending on the procedure, a cluster headache cycle can be stopped while it’s happening, and many procedures tend to come with very little side effects.

Despite the availability of treatment options, uptake has been limited due to lack of familiarity among clinicians.

“Procedures are not commonly trained in general neurology practice or in medical school, so it’s not something that everyone really understands how to do,” Jessica Ailani, MD, director of MedStar Georgetown Headache Center and associate professor of neurology at MedStar’s Georgetown University Hospital, told Healio Internal Medicine.

At the American Headache Society Annual Scientific Meeting,

Ailani led a discussion during a session on practical approaches to procedures in headache medicine to present evidence-based cases to help inform attendees as to what kinds of situations physicians should be conducting procedures.

FDA-approved procedure

OnabotulinumtoxinA (Botox, Allergan) is the only FDA-approved toxin that is used to treat chronic migraine.

The procedure is a series of injections that are administered every 12 weeks in patients with chronic migraine to help reduce the frequency and severity of headaches.

The COMPEL study presented at the American Academy of Neurology Annual Meeting demonstrated that onabotulinumtoxinA reduced headache day frequency by 10.7 days (P < .0001) in 373 patients who remained on therapy after nine treatment cycles.

Another common procedure that Ailani discussed is nerve blockers which aim to reduce abnormal signaling which can occasionally help reset the system and reduce the frequency of headaches.

The problem, Ailani said, is the effects of this procedure typically last between 2 and 4 weeks. She did highlight that there have been some studies that suggest performing this procedure on a weekly basis rather than monthly because that has been shown to allow patients to present with headaches in less than half the days in a month without causing serious side effects.

Additionally, physicians could use sphenopalatine ganglion blocks which involve a thin catheter placed in the nose to deliver medications that attack a bundle of nerves between the nose and the cheek.

However, as Ailani noted, there are multiple types of catheters and various ways of completing the procedure, which involves layers of complexity.

“Which way do you do it, which way is better, where do we have more evidence and what are the unanswered questions are things that we need to spend more time researching so we get a better understanding,” she said.

Becoming aware

Clinicians also should become more aware of research in the literature on migraine treatments, she said.

“Bringing some of that to light is important because that’s how we move the science forward,” Atlani said.

Clinicians are also being encouraged, Ailani said, to review techniques that have been used in previous studies. The goal, she noted, is for young clinicians to raise questions about what knowledge gaps might exist and conduct more research to address them.

“The hope is this might galvanize more physicians to be involved in projects where we can answer some of these questions, which will bring better care to our patients,” she said. – by Ryan McDonald

Disclosures: Ailani reports serving as a consultant for Alder Biopharmaceuticals, Allergan, Amgen, Avanir, Eli Lilly, gammaCore, Promius and Teva.