Unlike other headaches, migraines are complex and can present themselves differently at different times, she said.
“Patients who [experience] Migraines can cause nausea, vomiting, difficulty concentrating, sensitivity to light or noise, [and] Some may even experience an aura that drives the headache forward, “Mazan said.” And once they are pain-free, the patient may find they are tired, exhausted, or even irritable. “
While headaches can usually be treated with an OTC pain reliever, panelist Timothy R. Smith, MD, RPh, PharmD, CEO of StudyMetrix Research in St. Peters, Missouri, said that treating migraines can involve multiple steps.
Patients must first have a consultation to identify their symptoms and get an accurate diagnosis, followed by a prescription for effective treatment.
Research suggests health systems are struggling with these steps, Smith said.
For example, the American Migraine Prevalence and Prevention Study analyzed patients with episodic migraines and found that only 26% of those who experience these migraines actually received advice, an accurate diagnosis, and evidence-based treatment, he said.
In patients with more severe, chronic migraines, study results have shown that only 4.5% successfully completed these steps.
When considering appropriate treatments, the panelists said that prescribers need to consider both acute and preventive drugs, which have different goals.
Smith said the goal of therapy, according to the American Headache Society and the FDA, should be complete freedom from pain within 2 hours of ingestion.
“It’s kind of intuitive; we know patients want to be pain-free,” he said. “That is the greatest predictor of improvement and functionality ….[Patients also want] Freedom from the associated light symptoms [and] Sensitivity to noise and nausea with or without vomiting. “
However, despite the availability of traditional treatments, many patients receiving these prescriptions do not experience adequate pain and symptom relief, Smith said.
For example, study results show that more than 50% of patients who receive a prescription for triptans do not refill them within a year, although the reasons for this remain unclear, he said.
To address that unmet need, moderator Mark Percifield, PharmD, a registered on-site manager at Walgreens in Largo, Fla., Said the FDA has approved several new drugs, including the 5-HT1F receptor agonist lasmiditan (Reyvow).
The drug has been on the market for about 18 months and Percifield found it to be a serotonin agonist but not a triptan.
In particular, Lasmiditan does not cause vasoconstriction, which is a significant difference from the triptan class of drugs. However, because it has central penetrants and affects the central nervous system, Lasmiditan can cause side effects such as dizziness, fatigue, paresthesia and sedation.
Mazan also discussed the class of gepant drugs used to treat acute migraines, including Ubrogepant (Ubrelvy). The calcitonin gene related peptide (CGRP) protein is believed to be released during a migraine, so the CGRP antagonists work by blocking the receptor. Some CGRP antagonists have already been approved for chronic or preventive treatments, but Ubrogepant has received its first approval for the treatment of acute migraine.
Studies NCT00135304 and NCT02867709 and ACHIEVE-2 looked at the effectiveness of Ubrogepant and found that approximately 60% of patients experienced migraine relief after 2 hours. Specifically, approx. 20% of the patients were pain-free and approx. 40% were free of their most disturbing symptoms after 2 hours.
Appropriate detection and treatment of migraines is critical to the health and well-being of patients, concluded the panelists.
Migraines have a huge impact on patients’ quality of life, often resulting in their inability to perform normal activities, according to Amy R. Dunleavy, PharmD, pharmacist at Osterhaus Pharmacy in Maquoketa, Iowa.
“That throbbing pain, the nausea and vomiting, [and] that photo and sound sensitivity can really prevent the person from engaging in normal activities of daily living, [thus] keep them [from] being able to be active with loved ones and keep them from work, ”she said. “And for individuals [experiencing] Migraines can last for hours or even days. “
Percifield M, Dunleavy A, Mazan J, Smith T. Pharmacy Times Peer Exchange. June 2, 2021.