American Headache Society Consensus Statement on Integrating New Migraine Treatments
As more acute and preventive migraine treatments have been approved in recent years, and as evidence grows about postapproval usage, the American Headache Society (AHS) published an updated consensus statement in the journal Headache in June 2021.
"[T]he appropriate and cost-effective integration of these new treatments remains a high priority for prescribing clinicians," the authors wrote. "The American Headache Society, consistent with its mission of improving the lives of individuals impacted by headache, previously established indications for which the initiation and continuation of novel acute and preventive treatments might be appropriate."
The AHS had already published a consensus statement on the use of newly introduced treatments for adults with migraine. The 2021 update is based on the expanded evidence base and emerging expert consensus concerning post-approval usage, and provides practical recommendations in the absence of a formal guideline, according to the article.
"The integration of new treatments into clinical practice should be informed by the potential for benefit relative to established therapies, as well as by the characteristics and preferences of individual patients," the authors wrote.
However, they also noted that the consensus statement is not a clinical practice guideline.
The update involved a review of data about the efficacy, safety, and clinical use and review and commentary by the Board of Directors of the AHS and patients and advocates associated with the American Migraine Foundation.
Newly introduced acute treatments include:
* Two small-molecule calcitonin gene-related peptide (CGRP) receptor antagonists (ubrogepant, rimegepant);
* A serotonin (5-HT1F) agonist (lasmiditan);
* A nonsteroidal anti-inflammatory drug (celecoxib oral solution); and
* A neuromodulatory device (remote electrical neuromodulation).
New preventive treatments include eptinezumab, an intravenous anti-CGRP ligand monoclonal antibody.
Several modalities that may be appropriate for either acute or preventive treatment include:
* Neuromodulation (electrical trigeminal nerve stimulation, noninvasive vagus nerve stimulation, single-pulse transcranial magnetic stimulation); and
* Biobehavioral therapy (cognitive behavioral therapy, biofeedback, relaxation therapies, mindfulness-based therapies, acceptance and commitment therapy)
(See: Ailani J, Burch RC, Robbins MS. The American Headache Society consensus statement: update on integrating new migraine treatments into clinical practice. Headache. 2021;61(7)1021-1039. https://doi.org/10.1111/head.14153.)