On the topic of migraine prevention, the greatest development is the current research into monoclonal antibodies, according to Dr. Aurora. It is hoped that monoclonal antibodies will target the calcitonin gene-related peptide (CGRP) pathway to prevent migraines by blocking CGRP activity.
Dr. Aurora cited data that noted nearly 40% of patients should receive or could be considered for migraine preventive therapy, yet only 13% of those people who have migraine take daily preventive medication.2
The goals of prevention are to decrease migraine and headache days, decrease symptom intensity, and improve response to acute medications and functional ability.
“Consider prevention when [the migraine] significantly interferes with routine activities despite use of acute treatment, attack frequency exceeds one per week, and/or when there is an elevated risk of medication overuse and chronic daily headache, “ Dr. Aurora noted in her slides. Other situations when prevention should be considered include when acute medications are ineffective or overused; when uncommon migraine symptoms are present, including prolonged aura; and in the setting of migrainous infarction.
She explained that several medications are being used for chronic migraine. OnabotulinumtoxinA is approved by the US Food and Drug Administration for treatment of chronic migraine and has been evaluated in double-blind, placebo-controlled studies. She cited data that prophylactic treatment significantly improved quality of life, in terms of emotional functioning and other measures, at 24 weeks compared with placebo.3