Francesca Puledda, a neurologist from King's College London and author of the International Headache Society's guidelines, shares valuable insights on migraine management. She highlights the importance of tailoring treatment to individual patient needs and regional medication availability. The discussion covers acute treatments like triptans, unique considerations for pregnant women, and the complexities of preventive therapies. Puledda emphasizes a patient-centric approach that balances diverse options with satisfaction, ensuring comprehensive care for migraine sufferers.
The International Headache Society's guidelines offer a two-tiered approach to migraine treatment, addressing varying medication availability globally.
Early administration of triptans is crucial for acute migraine relief, while preventive treatments should be personalized based on frequency and patient preferences.
Deep dives
Global Practice Guidelines for Migraine Treatment
The International Headache Society developed comprehensive practice guidelines for the treatment of migraines, taking into account the global variability in medication availability. These recommendations are structured into two levels: optimal and essential, aiming to provide evidence-based guidance while ensuring accessibility for healthcare providers worldwide. For instance, the optimal level suggests advanced pharmacological treatments, while the essential level includes options based on expert opinion for areas with less medication availability. This approach allows for a more inclusive set of recommendations applicable in diverse clinical settings.
Acute Treatment Recommendations
For patients experiencing acute migraine attacks, the guidelines emphasize the early use of triptans for those who do not find relief with first-line analgesics. Specific guidance dictates that triptans should be administered as early as possible to maximize efficacy, avoiding use during the aura phase when possible. It was mentioned that sumatriptan serves as a common baseline choice due to its extensive study, while other triptans have unique characteristics influencing efficacy and tolerance. If two triptans fail to provide adequate relief within a reasonable time frame, exploring alternative classes of medication is advised to improve treatment outcomes.
Preventive Treatment Strategies
The guidelines recommend considering preventive treatments for individuals with frequent migraines, defined by specific criteria such as more than four headache days per month or significant life impact. Patient-centered decision-making is emphasized, weighing personal preferences alongside the severity and frequency of migraines. There is also a growing understanding that the combination of preventives, especially newer therapies like CGRP monoclonal antibodies, may offer more effective solutions for those only partially responding to first-line treatments. Furthermore, considerations for treatments during pregnancy are addressed, recommending non-pharmacological approaches first, with specific medications suggested when necessary.
Dr. Jessica Ailani talks with Dr. Francesca Puledda about the International Headache Society's global practice recommendations for the acute and preventive treatment of migraine.
Read the related recommendations for the acute pharmacological treatment of migraine in Sage Journals.
Read the related recommendations for pharmacological treatment of migraine in Sage Journals.