CONSIDERATIONS FOR
MANAGING MIGRAINE
THROUGHOUT THE PATIENT JOURNEY
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© 2020 Amgen Inc. All rights reserved.
Migraine: An overview of the
patient journey
patient journey
Consultation
- Can be conducted by specialists and non-specialists1
Diagnosis
- ~ 44% of patients with migraine have not received a diagnosis2
- Rule out other headache diagnoses3
Referral
- PCPs may consider referring patients to specialists as needed4
Drug Treatment—Acute and preventive
- Patients with frequent migraine attacks (≥ 4MHDs) may require both preventive and acute medications as part of their treatment plan5
- ~ 2 out of 3 patients who qualify for preventive treatment do not receive it6
- 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%
Follow-up
- ~ 80% of patients discontinue preventive treatments commonly due to efficacy or safety/tolerability concerns7,8
Acute and preventive treatment
overview
overview
ACUTE
PREVENTIVE
Used to abort a migraine attack1,2
Eligible for
many patients1
Possibility for
overuse1-3
Reduces migraine attack frequency,
Consider for patients with severe and/or frequent headaches that are not controlled with acute treatment1
Treatment choice factors include drug efficacy/safety, concomitant medications, comorbidities, and patient preference1,4-6
© 2020 Amgen Inc. All rights reserved. USA-334-83138 11/19
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References. 1. Diener HC, Solbach K, Holle D, Gual C. Integrated care for chronic migraine patients: epidemiology, burden, diagnosis and treatment options. Clin Med. 2015;15(4):344-350.
2. Diamond S, Bigal ME, Silberstein S, Loder E, Lipton RB. Patterns of diagnosis and acute and preventive treatment for migraine in the United States: results from the American Migraine Prevalence and Prevention study. Headache. 2007;47(3):355-363.
3. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211. https://doi.org/10.1177/0333102417738202.
4. Starling AJ, Dodick DW. Best practices for patients with chronic migraine: burden, diagnosis, and management in primary care. Mayo Clin Proc. 2015;90(3):408-414.
5. American Headache Society. The American Headache Society position statement on integrating new migraine treatments into clinical practice. Headache. 2019;59(1):1-18.
6. Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007;68(5):343-349.
7. Hepp Z, Dodick DW, Varon SF, Chia J, Matthew N, Gillard P, Hansen RN, Devine EB. Persistence and switching patterns of oral migraine prophylactic medications among patients with chronic migraine: A retrospective claims analysis. Cephalalgia. 2017;37(5):470-485.
8. Blumenfeld AM, Bloudek LM, Becker WJ, Buse DC, Varon SF, Maglinte GA, Wilcox TK, Kawata AK, Lipton RB. Patterns of use and reasons for discontinuation of prophylactic medications for episodic migraine and chronic migraine: results from the second international burden of migraine study (IBMS-II). Headache. 2013;53(4):644-655.
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References. 1. American Headache Society. The American Headache Society position statement on integrating new migraine treatments into clinical practice. Headache. 2019;59(1):1-18.
2. Marmura MJ, Silberstein SD, Schwedt TJ. The acute treatment of migraine in adults: the American headache society evidence assessment of migraine pharmacotherapies. Headache. 2015;55(1):3-30.
3. Giamberardino MA, Martelletti P. Emerging drugs for migraine treatment. Expert Opin Emerg Drugs. 2015:20(1):137-47.
4. Silberstein SD, Holland S, Freitag F, et al. 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;78:1337-1345.
5. Reddy DS. The pathophysiological and pharmacological basis of current drug treatment of migraine headache. Expert Rev Clin Pharmacol. 2013:6:271-288.
6. D'Amico D, Tepper SJ. Prophylaxis of migraine: general principles and patient acceptance. Neuropsychiatr Dis Treat. 2008;4:1155-1167.