Migraine frames so many of her moments. Even the ones you wouldn't suspect.
See what your patients aren't saying about their migraine.
Is There a Need to Reassess Migraine Management?
Millions of people suffer from migraine in the US.1 Although multiple medications and devices are approved for treatment, diagnosis and treatment adherence remain challenging, reflecting the need for continued advancement in migraine management.1-3
According to the American Migraine Prevalence and Prevention (AMPP) Study (n=18,968)3:
of those suffering from migraine received a migraine diagnosis3
of patients with migraine were eligible for preventive treatment, but less than half actually received a preventive treatment1
In a US Claims Database Study (n=40,892):
of patients who received a new triptan prescription did not persistently refill their prescriptions over a 2-year period4
Why Are Migraine Treatments Being Underutilized?
Many people who use a migraine treatment do not achieve desired efficacy or have difficulty tolerating their medicine.5,6 Estimates also suggest that a majority of patients who start a preventive treatment for migraine discontinue using it.3,7,8 When faced with these challenges, consider assessing the impact that migraine is having on the lives of your patients.
The Impact Surrounding Migraine
People living with migraine not only have to suffer from the pain of an attack, but also the impact migraine has on many aspects of their lives. Migraine can cause patients to miss out on time with their families or activities they enjoy, negatively affecting important personal relationships, and impacting their performance at work.9 When people with migraine experience frequent attacks, and fear when the next one will strike, it can interfere with their personal and professional lives.10 But many patients may not acknowledge or communicate the true impact of migraine to their healthcare providers.9, 11
The impact goes beyond pain:
Just 1 migraine headache per week can lead to over 50 unproductive, lost days per year1
73.4% of people with moderate-frequency episodic migraine (5 to 9 headache days [HD] per month) with children reported levels of significant reduction in involvement or enjoyment in family activities one or more times in the past 30 days, according to the CaMEO study (n=436)12
Despite the compelling statistics, migraine remains under-recognized and undertreated.3, 13, 14 When the impact of migraine is better understood, you and your patients can better uncover how life-altering migraine attacks can be, and work together with the goal of improved management.
CaMEO = Chronic Migraine Epidemiology and Outcomes
Help Your Patients by Assessing the Impact of Migraine
A thorough migraine impact assessment begins by reframing the conversation with your patients to go beyond the physical symptoms of migraine. This helps you uncover a more complete picture of the burden migraine is placing on your patients’ lives. This deeper understanding can allow you to recommend a treatment plan that may be right for your patient, and may assist in determining appropriate candidates for prevention.
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From Impact Assesment to Developing a Treatment Plan
It is important to develop a treatment plan that may help reduce the impact of migraine on a patient’s life. Treatment plans may include non-pharmacological options, including lifestyle modifications, trigger avoidance, and relaxation therapies.2,15 Pharmacologic approaches include acute treatments, which are used to treat acute migraine attacks as they occur, and preventive treatments, which are used to reduce the frequency of migraine attacks.16
According to the AMPP study, which evaluated 18,968 patients with migraine, nearly 40% are candidates for a preventive treatment, and yet only 12.4% of those eligible currently use a preventive.1 Of those who do begin a preventive, less than half remain on treatment.17
If a patient did not experience a clinical benefit from treatment in the past, he or she can be reassessed for the impact of migraine, and other treatment strategies may still be considered. Once a patient has been thoroughly assessed, a treatment plan can be created to help address your patient’s needs.
When discussing treatment plans with your patients, understanding the latest developments in the pathophysiology of migraine is key to reframing the conversation you have with them.
Emerging Science in Migraine Research: The Role of CGRP
Researchers continue to uncover intriguing details about migraine. There are a number of neuropeptides that have been investigated in the complex mechanism of migraine, some of which include CGRP, oxytocin, serotonin, Substance P, and vasoactive intestinal peptide.18-20
A body of migraine research over the last few decades suggests that the release of CGRP from trigeminal nerves may play a central role in the pathophysiology of migraine.21 Understanding the role of CGRP in migraine can help you give patients a better understanding of their disease.
CGRP = calcitonin gene-related peptide
Linking CGRP and Migraine
A close look at the trigeminovascular system reveals the potential role of CGRP in migraine. Stimulation of the trigeminal sensory nerves causes the release of several neuropeptides, including CGRP. Although trigeminal sensory nerves store several neuropeptides, CGRP levels have been shown to be elevated during migraine and return to baseline as pain is alleviated.21
The Correlation Between CGRP and Migraine
Research linking CGRP and migraine suggest21:
CGRP levels have been shown to be elevated during a migraine attack and return to baseline as pain is alleviated
CGRP is released after nerve activation
Perivascular release of CGRP contributes to neurogenic inflammation by inducing vasodilation and dural mast cell degranulation
CGRP is involved in the transmission of pain
Infusion of CGRP can induce migraine attacks in those susceptible to migraine headaches
Understanding both the full burden of migraine and the pathophysiology of migraine can help you reframe how you talk to your patients about their disease and treatment plan.
Lilly's Commitment to Headache
Lilly has been researching headache disorders including migraine for many years, for both acute and preventive treatment. All compounds studied have had non-opiate mechanisms of action without vasoconstrictive effects.
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- Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF; for the AMPP Advisory Group. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007;68(5):343-349.
- Kalra AA, Elliott D. Acute migraine: current treatment and emerging therapies. Ther Clin Risk Manag. 2007;3(3):449-459.
- Diamond S, Bigal ME, Silberstein S, Loder E, Reed M, 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.
- Katic BJ, Rajagopalan S, Ho TW, Chen YT, Hu XH. Triptan persistency among newly initiated users in a pharmacy claims database. Cephalalgia. 2011;31(4):488-500.
- Holland S, Fanning KM, Serrano D, Buse DC, Reed ML, Lipton RB. Rates and reasons for discontinuation of triptans and opioids in episodic migraine: results from the American Migraine Prevalence and Prevention (AMPP) study. J Neurol Sci. 2013;326(1-2):10-17.
- Blumenfeld AM, Bloudek LM, Becker WJ, et al. 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.
- Loder EW, Rizzoli P. Tolerance and loss of beneficial effect during migraine prophylaxis: clinical considerations. Headache. 2011;51(8):1336-1345.
- Berger A, Bloudek LM, Varon SF, Oster G. Adherence with migraine prophylaxis in clinical practice. Pain Pract. 2012;12(7):541-549.
- Mannix S, Skalicky A, Buse DC, et al. Measuring the impact of migraine for evaluating outcomes of preventive treatments for migraine headaches. Health Qual Life Outcomes. 2016;14(1):143.
- Headache disorders fact sheet. World Health Organization website. Updated April 2016. Accessed October 23, 2017.
- Hahn SR, Lipton RB, Sheftell FD, et al. Healthcare provider–patient communication and migraine assessment: results of the American Migraine Communication Study, phase II. Curr Med Res and Opin. 2008;24(6):1711–1718
- Buse DC, Scher AI, Dodick DW, et al. Impact of migraine on the family: perspectives of people with migraines and their spouse/domestic partner in the CaMEO study. Mayo Clinic Proc. 2016;91(5):596-611
- Migraine facts. Migraine Research Foundation website. Accessed October 23, 2017.
- Stovner LJ, Hagen K, Jensen R, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia. 2007;27(3):193-210.
- Chopra R, Robert T, Watson DB. Non-pharmacological and pharmacological prevention of episodic migraine and chronic daily headache. W V Med J. 2012;108(3):88-91.
- Center for Drug Evaluation and Research. Migraine: Developing Drugs for Acute Treatment, 2014. Silver Spring, MD: Center for Drug Evaluation and Research, US Food and Drug Administration; 2017.
- Hepp Z, Dodick, DW, Varon SF, et al. Persistence and switching patterns of oral migraine prophylactic medications among patients with chronic migraine: A retrospective claims analysis. Cephalalgia. 2017;37(5):470-485.
- Edvinsson L, Uddman R. Neurobiology in primary headaches. Brain Res Rev. 2005;48(3):438-456.
- Tzabazis A, Mechanic J, Miller J, et al. Oxytocin receptor: expression in the trigeminal nociceptive system and potential role in the treatment of headache disorders. Cephalalgia. 2016;36(10):943-950.
- Aggarwal M, Puri V, Puri S. Serotonin and CGRP in migraine. Ann Neurosci. 2012;19(2):88-94.
- Durham PL. CGRP-receptor antagonists — A fresh approach to migraine therapy? N Engl J Med. 2004;350(11):1073-1075.