Improving, Optimizing Treatment for Migraine

During a session at the 2018 Scottsdale Headache Symposium, Michael Ready, MD, FAHS, discussed how to develop an effective migraine preventative plan.

According to Dr Ready, migraine is best defined as a chronic condition with episodic attacks. He explained that patients with migraine inherited a nervous system that has an higher potential for a disabling attack, the nervous system perceives environmental stimulation at lower levels and retains that activation for a longer period of time.

Dr Ready said that a common question asked among patients with migraine regards what they did to have “one.” He said that this question is appropriate for patients with infrequent attacks. He also explained that for patients experiencing an increased number of migraine episodes, the best acute interventions lose their effectiveness, and he said that with an increasing number of episodes, patients often experience worsened comorbidities to the point that the generated stress leads to chronic migraine.

“Consequently, as migraine frequency increases so does the need for effective prevention,” he said.

According to Dr Ready, an effective preventive intervention for patients with migraine should raise the migraine “threshold” rendering it harder for a provocation to precipitate and attack. Additionally, he explained that an effective migraine preventive plan should assess what is making the sensitive brain more susceptible to an attack.

“Identified factors that have been associated migraine progression include migraine frequency, poor acute treatment, sleep disorders, medication overuse, obesity, unmanaged stress, and caffeine,” he said. “These factors should be seen as pieces of a puzzle where a certain number have to be identified in order to envision final image.”

Dr Ready then explained that for effective migraine prevention, clinicians should be cognizant of the common reasons for suboptimal response. He said that the prevention plan should incorporate a measure to identify and addresses those failures.

“Effective migraine prevention isn’t just one thing such as what medication to prescribe,” he said. “It’s an adventure in problem solving.”—Julie Gould