by Carrie Dougherty, MD, FAHS

The results of the AMPP in 2007 showed that many migraine patients eligible for preventive treatment were not receiving it (1). Similar to the AMPP, the OVERCOME study is a survey study that provides important epidemiologic information on characteristics of migraine patients and reflects more recent treatment patterns. The results presented here show that, unfortunately, over a decade after the AMPP, the majority of patients still do no receive preventive treatment when indicated.  

Seeing a clinician and receiving an accurate diagnosis are the first hurdles patients must overcome in order to receive appropriate treatment. This study shows that patients who are insured, have migraine associated symptoms and disability are more like to take preventives. Presumably, this is because patients who are insured have better access to care, and those with associated features and disability are more likely to be recognized as migraine.

According to the current AHS position paper on use of novel treatments for migraine, patients need to try two generic oral preventives prior to consideration of the CGRP targeted monoclonal antibodies (mAbs) (2). Unfortunately, what is shown by the OVERCOME results is that due to the very low rates of preventive use, a downstream effect is that few will qualify for treatment with CGRP targeted preventives. In this study, only 14% of those identified to qualify for preventive treatment would be candidates for a CGRP mAb. The authors raise a prudent concern than setting the bar for CGRP mAbs only after two prior generic preventives, may perpetuate barriers to more specific and potentially better tolerated treatments. Hopefully this study will continue to raise awareness amongst clinicians on the importance of preventive treatment of migraine and raise further discussion about when to recommend new medications. 

 

References

 

1. Lipton RB, Bigal ME, Diamond M, et al. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007;68(5):343-349. doi:10.1212/01.wnl.0000252808.97649.21
2. American Headache Society. The American Headache Society Position Statement On Integrating New Migraine Treatments Into Clinical Practice. Headache. 2019;59(1):1-18. doi:10.1111/head.13456