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American Headache Society Annual Meeting
July 13, 2018
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Most patients with migraines have multiple unmet medical needs

Richard Lipton
Richard B. Lipton

SAN FRANCISCO — More than 90% of patients with migraines who are taking acute prescription migraine medications have multiple unmet medical needs, a presenter at the American Headache Society Annual Scientific Meeting said.

“The vast majority of these patients are not treated by a headache specialist but …  are treated in primary care settings,” Richard B. Lipton, MD, of the department of neurology at Albert Einstein College of Medicine in New York, told attendees. “There are lots of opportunities to use new and emerging tools to improve the lives of our patients.”

Researchers presented common headache attack, treatment response and patient characteristics to 3,930 patients reporting migraine and taking oral medications and were participants in a web-based survey. An ‘unmet need’ was classified as such if the respondent indicated it occurred rating of half the time, more, or always during their headaches.

Lipton and colleagues reported that 90.8% of respondents had one or more of the following unmet headache attack needs: impact on sleep; Migraine Disability Assessment Score of severe or moderate; nausea; and rapid onset of attack.

Researchers made the following treatment recommendations:

  • Treat the headache early and consider methods that prevent migraines (this can be utilized for both impact on sleep and the severe or moderate scores);
  • Treat the patient with an antiemetic and/or nonoral treatments; and
  • Treat the headache early with a rapid, onset oral medication or consider a nonoral medication.

The researchers also found that 76% of the survey takers had one or more of the following unmet treatment responses: delay in taking prescriptions due to fear of adverse events; ED or urgent care use for headache; inadequate 2-hour pain freedom; pain recurrence; and treatment-related nausea

Lipton and colleagues made the following treatment recommendations based on those results:

  • Choose a better tolerated acute treatment;
  • Provide a rescue treatment plan for when initial treatment use fails;
  • Select a fast or more effective, nonoral agent;
  • Select long half-life products with low recurrence rates; and
  • Nonoral therapy.

Researchers also reported that 16.1% of respondents had both cardiovascular comorbidity and had overused opioids and barbiturates. In these cases, Lipton and colleagues recommended medications with minimal cardiovascular-related adverse events and withdrawing overused medication, adding a medication that either prevents migraines or is from another treatment class.

“There was a lot of overlap in terms of unmet need which we are in the process of trying to sort out. Common areas of unmet need may well respond to current available treatments or options that are coming,” Lipton said. – by Janel Miller  

Reference: Lipton RB, et al. Assessing unmet treatment needs and associated disability in persons with migraine: Results from Migraine in America Symptoms and Treatment (MAST) Study. Presented at: American Headache Society Annual Scientific Meeting; June 28-July 1, 2018; San Francisco.

Disclosure: Healio Family Medicine was unable to determine the authors’ relevant financial disclosures prior to publication.