Migraine and prophylaxis
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THERAPEUTICAL SCENARIOS IN HEADACHES
Migraine and prophylaxis Licia Grazzi 1
# Fondazione Società Italiana di Neurologia 2020
Migraine is a complex and disabling condition [1] and the problem of treatment of this disease has been largely debated in the last years. Migraine can be associated with great and significant disability, high impact on physical, social and occupational functioning, and worse health-related quality of life, in particular in chronic forms. About 3% of patients with episodic migraine (EM) progress to chronic migraine (CM) each year; patients can fluctuate between EM and CM [1, 2]. CM is often complicated by medication overuse that makes this condition more difficult to treat. Patients with migraine often need prophylactic treatment to reduce the frequency of pain attacks, severity, and associated disability and to reduce the risk of medication overuse. In some cases, a simple pharmacological treatment is not enough to manage this category of patients so the opportunity to include nonpharmacological approaches to help patients during their therapeutic process has to be considered. In the last decades, clinical experiences on migraine and chronic migraine with medication overuse have indicated that patients have to be educated to the correct use of symptomatic medications, and to the evaluation of their headache history, pharmacological treatments, and their habits: bad habits may induce the increase of headache attacks. Also, a particular attention to mental stress and stressful life events has to be encouraged, as these aspects have a significant impact on clinical condition. Concerning specific prophylaxis therapies for migraine, innovative therapies are on the market to reduce the high burden of migraine. In fact, recently, monoclonal antibodies that target the calcitonin gene-related peptide (CGRP) pathway of
* Licia Grazzi [email protected] 1
Headache Center, Neuroalgology Department, IRCCS Foundation “Carlo Besta” Neurological Institute, Milan, Italy
migraine pathogenesis have been specifically developed for the prophylactic treatment of different forms of migraine. These new molecules have demonstrated good efficacy and excellent tolerability in phase II and III clinical trials and also in the preliminary real-life studies. They are a new and interesting option for patients who reported failures from different prophylactic therapies. These innovative treatments can be considered a “revolution” in the history of migraine therapies: this is the first preventive therapy specifically addressed to the treatment of migraine: the medications used in the past for migraine prophylaxis were, in the most part of cases, applied for treating other clinical conditions and their use for migraine was not specific. Traditionally, headache and migraine, in particular, have been considered from a limited perspective, both medically and psychologically. The new model that has been proposed explains how migraine is a condition where an interaction of biological, psychological, and social v
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