Characteristics of Individuals with Migraine Who Are Eligible for Novel CGRP Monoclonal Antibodies: Results of the OVERCOME Study

Richard B. Lipton, MD

AHSAM 2020 - Oral session
Published on July 30, 2020

1 minute listen

6 minute read

Key messages

  • Access to migraine prevention treatment is influenced by sociodemographic factors and less than a third of people requiring treatment are receiving it.
  • Empirical research is required to improve access to preventative treatments and to inform the revision of the AHS Position Statement.
  • Background

    What do we already know about this topic?
  • Findings

    What does this study add?
  • Perspectives

    How does this study impact clinical practice?
  • Expert commentary

    by Carrie Dougherty, MD, FAHS

Key messages

  • Access to migraine prevention treatment is influenced by sociodemographic factors and less than a third of people requiring treatment are receiving it.
  • Empirical research is required to improve access to preventative treatments and to inform the revision of the AHS Position Statement.

Background

What do we already know about this topic?

  • The American Headache Society’s (AHS) position statement recommends migraine patients should experience the failure of two preventative medications before receiving CGRP (Calcitonin Gene-Related Peptide) targeted mAb (monoclonal antibody) treatment. 1
  • The 2018 OVERCOME (ObserVational survey of the Epidemiology, tReatment and Care Of MigrainE) web-based survey provides a US representative sample (n=21,143) of the migraine healthcare landscape.

How was this study conducted?

  • A moderate-to-severe disability group (n=5,895) of migraine patients was selected from the OVERCOME survey using MHD (monthly headache days) ≥ 4 and MIDAS (Migraine Disability Assessment) ≥ 11. Subgroups were then created based upon patients being prescribed or recommended 0, 1, or ≥2 medications.2
  • Sociodemographic differences and migraine-related factors by the number of recommended migraine prevention medications were analyzed using a t-test (continuous variables) or Chi-square test (categorical variables). 3-5

Findings

What does this study add?

  • 14% of patients used ≥2 preventative migraine medications and, therefore, would be immediately eligible for CGRP mAbs treatment.
  • An additional 17.6% tried one preventative medication and would need to fail another to be eligible.
  • Less than one-third of patients in need of a migraine prevention treatment have received one.
  • Patients are more likely to take migraine prevention medication if they have health insurance, higher migraine-related symptoms, greater migraine-related disability, and are diagnosed.

Perspectives

How does this study impact clinical practice?

  • Patterns associated with demographic, headache characteristics and healthcare-seeking behaviors can be used to inform strategy for improving access and outcomes to preventative treatments.
  • Empirical research is required to determine the most cost-effective and cost-effective framework for sequencing preventative treatments, and to inform a revision of the AHS Position Statement.

Perspectives

How does this study impact clinical practice?

  • Patterns associated with demographic, headache characteristics and healthcare-seeking behaviors can be used to inform strategy for improving access and outcomes to preventative treatments.
  • Empirical research is required to determine the most cost-effective and cost-effective framework for sequencing preventative treatments, and to inform a revision of the AHS Position Statement.

This is a highlights summary of an oral session given at the AHSAM 2020 Virtual Annual Scientific Meeting and presented by:

Richard B. Lipton, MD
Professor and Vice Chair of Neurology
Albert Einstein College of Medicine
Bronx, New York

The content is produced by Infomedica, the official reporting partner of ASHAM 2020 Virtual Annual Scientific Meeting. The summary text was drafted by Goldcrest Medical Writing, reviewed by Marco Vercellino, MD, an independent external expert, and approved by Jessica Ailani, MD, FAHS and Mark J. Burish, MD, PhD, the scientific editors of the program.

The presenting authors of the original session had no part in the creation of this conference highlights summary.

In addition, an expert commentary on the topic has been provided by:

Carrie Dougherty, MD, FAHS
Associate Professor of Neurology
Fellowship Program Director, Headache Medicine
Assistant Residency Program Director, Neurology
MedStar Georgetown University Hospital

Carrie Dougherty, MD, FAHS
Associate Professor of Neurology
Fellowship Program Director, Headache Medicine
Assistant Residency Program Director, Neurology
MedStar Georgetown University Hospital

Carrie Dougherty, MD, is associate professor of neurology and program director of the headache medicine fellowship at MedStar Georgetown University Hospital in Washington, DC. She is a fellow of the American Headache Society and serves as a member of the Guidelines committee and the Scottsdale Headache Symposium Planning committee. She is secretary of the Southern Headache Society and the Alliance for Headache
Disorders Advocacy.

1. American Headache Society. The American Headache Society Position Statement on Integrating New Migraine Treatments Into Clinical Practice. Headache 2019;59:1-18.

2. Silberstein SD, et al. Evidence-based Guideline Update: Pharmacologic Treatment for Episodic Migraine Prevention in Adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology 2012;78:1337-1345.

3. Lipton RB, et al. Cutaneous Allodynia in the Migraine Population. Annals of Neurology 2008;63:148-158.

4. Lipton RB, et al. Validity and Reliability of the Migraine-Treatment Optimization Questionnaire. Cephalalgia 2009;29:751-759.

5. Stewart WF, et al. Development and Testing of the Migraine Disability Assessment (MIDAS) Questionnaire to Assess Headache-Related Disability. Neurology 2001;56(6 Supp 1):S20-28.



Headache
Migraine


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