April 2025
Position statement calls for more ambitious migraine treatment goals
By Rebecca Jenkins
More ambitious migraine treatment goals are needed to enhance patient outcomes and reduce the broader impact on work productivity and quality of life, an international expert panel recommends.
In an International Headache Society position statement published in Cephalalgia, expert authors from 12 countries, including Australia, said newer preventative migraine medications, including treatments targeting the calcitonin gene-related peptide (CGRP) pathway and onabotulinumtoxinA, had proved effective and better tolerated then previously available therapies.
‘Clinical trials and real-world studies had shown that significant reductions in migraine frequency and, in some cases, complete migraine freedom was achievable,’ the authors wrote.
Standard treatment goals required at least a 50% reduction in monthly migraine days or moderate-to-severe headache days, with at least a 30% reduction being acceptable when no superior alternative exists, but this approach did not address any residual migraine symptoms.
Instead, the position statement called for a paradigm shift to a new approach categorising patient outcomes into four tiers according to the number of migraine or moderate-to-severe headache days per month experienced while on treatment. The four tiers were migraine freedom (no days with migraine or moderate-to-severe headache), optimal control (less than four days), modest control (four to six days) and insufficient control (more than six days).
‘The primary clinical implication and the core objective is to foster a more ambitious perspective in migraine management, striving to provide individuals with migraine a normal or near-normal quality of life despite the presence of the disease,’ the authors wrote.
‘This represents a substantial shift from the current mindset, where the primary goal of preventive treatment focuses on achieving relative improvement.’
They added that the position statement did not seek to change the standards for clinical trials, noting it was also important to maintain the standard criteria of efficacy when considering drug reimbursement to ensure equitable access.
Position statement coauthor Dr Faraidoon Haghdoost, Headache Researcher at The George Institute for Global Health, Australia, said focusing only on a 50% reduction left some patients to cope with a significant number of headache days every month.
‘For example, if someone experiences 20 days of migraine or headache per month, a 50% reduction would still leave them with 10 headache days,’ he told Medicine Today.
‘While this means giving back 10 days of life, the person may still face disability and challenges in their personal, work and social life because of the remaining 10 days of headache.’
The main goal of the position statement was to see the approach applied in clinical practice, he said.
‘This can happen if guide lines change to advise clinicians, and if clinicians’ mindsets also evolve to accept it,’ he said.
Achieving the proposed goals might progress at different rates and be slower in some regions, particularly in countries where anti-CGRP medications were not available, Dr Haghdoost noted.
‘But shifting the mindset in those countries can lead to policy changes, improved medication availability and eventually guideline updates,’ he said.
Cephalalgia 2025; 45: 1-11 (https://journals.sagepub.com/doi/10.1177/03331024251320608).