Migraine treatment is often classified as either acute or preventive treatment. In this slide deck you will find basic concepts and definitions related to modern treatment approaches such as the use of analgesics and NSAIDs, as well as more targeted therapies, such as triptans and CGRP medications. The slide deck also offers a brief introduction to non-pharmacological migraine treatment and current migraine management issues.

This slide deck has been developed for Neurotorium in collaboration with Cambridge Medical – A Prime Global agency and Bjarke Ebert H. Lundbeck A/S. Reviewed by Clinical Research Associate Professor Henrik Winther Schytz, Danish Headache Center, Rigshospitalet Glostrup.

Index for
slide deck

Introduction

Migraine Treatment Principles Slide1
Treatment principles
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Migraine Treatment Principles Slide2
Historical context for migraine treatment

There have been many historical approaches to treating headaches,[Koehler & Boes, 2010; Pearce, 1986] but modern approaches centre around the use of analgesics, NSAIDs, and more targeted therapies, such as triptans and CGRP related agents.[Martelletti & Giamberardino, 20…

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Migraine treatment and management

Migraine Treatment Principles Slide3
Migraine treatment and management
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Migraine Treatment Principles Slide4
Clinical treatment guidelines

Clinical guidelines for the treatment and management of migraine aim to aid clinicians and thereby improve care. Variations in the weight given to different empirical data and their consequences for clinical practice influence the guidelines, and consequently, at the mom…

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Migraine Treatment Principles Slide4b
European recommendations for treatment and management of migraine in adults

A consensus statement from 2021, endorsed by the European Headache Federation and the European Academy of Neurology, introduce ten steps to diagnose and manage migraine [Eigenbrodt et al., 2021]. The importance of having a patient centeret approach, prioritizing patient …

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Migraine Treatment Principles Slide5
Medication overuse

Although not fully understood, the use of certain medications in certain individuals is thought to lead to structural and/or functional brain changes, altering their susceptibility to headaches and migraine.[Chong, 2020; Da Silva & Lake, 2014; Kocasoy Orhan, 2019] Over t…

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Migraine Treatment Principles Slide6
Treatment of migraine in young people

Migraine in children is a common and disabling disease.[Hershey, 2010; Teleanu, 2016] The prevalence of migraine is thought to increase throughout childhood, and peak post-puberty – perhaps accounted for by menstrual migraine in girls.[Teleanu, 2016] Only a minority of c…

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Pharmacological treatment of acute migraine

Migraine Treatment Principles Slide7
Pharmacological treatment of acute migraine
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Migraine Treatment Principles Slide8
Strategies for acute treatment of migraine in adults – stepped and stratified care

In stepped care: [Lipton et al., 2000]

• Acute treatment starts with simple analgesics.
• If there’s insufficient or no response, the patient is offered migraine specific treatment.

Stepped care can be applied within or across attacks.[Ashina et al., 2021; Lipton et…

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Migraine Treatment Principles Slide9
Acute pharmacological treatment of migraine

Treatment guidelines and consensus statements for the treatment of migraine has been published by The American Academy of Neurology (AAN), jointly with several organisations including the American Headache Society (AHS), and by the European Headache Federation (EHF), end…

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Migraine Treatment Principles Slide10
Analgesics

Both European, American and Canadian treatment guidelines rank the evidence supporting some NSAIDs and other analgesics as high – that is, established as effective for acute migraine treatment based on available evidence.[Marmura et al., 2015; Worthington et al., 2013] C…

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Migraine Treatment Principles Slide11
Triptan therapy

Treatment guidelines for migraine rank the evidence supporting triptan therapy in the highest tier – that is, established as effective for acute migraine treatment based on available evidence.[Marmura et al., 2015; Worthington et al., 2013] Individual triptan therapies h…

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Migraine Treatment Principles Slide12
Efficacy of triptan therapy

In meta-analyses, most triptan therapies were found to be more effective than NSAIDs, ergots, and certain analgesics.[Cameron et al., 2015; Thorlund et al., 2014] However, among the triptan therapies, multiple-treatment comparison modelling has revealed a hierarchy of ef…

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Migraine Treatment Principles Slide13
Ditans

The cardiovascular adverse effects of triptans – described as their ‘Achilles’ heel’ – led to the development of the ditans (selective serotonin receptor 1F agonists).[González-Hernández et al., 2018] Ditans appear to lack the strong vasoconstrictor effects seen with tri…

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Migraine Treatment Principles Slide14
Gepants

Nonpeptide CGRP receptor agonists are called gepants. Gepants are a newer class of drugs, some of which have recently been approved by the FDA and EMA for the acute treatment of migraine in adults [Ashina et al. 2021; EMA, 2022; FDA, 2022].

References:
Ashina M, Buse D…

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Migraine Treatment Principles Slide15
Adjunct treatment - Antiemetics (anti-nausea agents)

Treatment guidelines recommend the use of antiemetics as adjunctive therapy – an add on to the antimigraine therapy.[Marmura et al., 2015; Worthington et al., 2013] Certain antiemetics are strongly recommended alongside migraine medication in patients with migraine for t…

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Migraine Treatment Principles Slide16
Other pharmacological treatments

Treatment guidelines rank the evidence supporting individual ergot alkaloids as ranging from strong to relatively poor. Some guidelines recommend the use of ergot alkaloids in treating migraine, albeit weakly.[Marmura et al., 2015; Worthington et al., 2013]

However, m…

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