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Time to rethink chronic migraine classification and other highlights from American Headache Society congress

This year’s virtual congress brought together 900 delegates from over 30 countries to attend live-streamed sessions, live Q&A, and pre-recorded lectures available on demand. Content will be available online to registered participants for the next 12 months. These were some of the highlights.

Is it time to rethink chronic migraine classification?
Leading US migraine specialists are questioning the 15 headache days/month threshold for differentiating episodic and chronic migraine following an analysis showing that it does not adequately capture the burden of illness or reflect treatment needs.

Head-to-head study shows CGRP MAb therapy superior to standard of care in migraine prevention
Data from the first randomised controlled trial of MAb therapy versus standard of care in migraine prevention have shown a higher responder rate with erenumab compared with topiramate and fewer treatment discontinuations.

Clinicians urged to document bridge therapies used to address CGRP MAb wearing-off
Clinicians are being encouraged to document the use and benefit of bridge therapies for patients who experience CGRP MAb wearing off during migraine treatment. This follows a retrospective chart review of patients attending a US headache centre which showed wearing-off in 20% of patients, equivalent to approximately 25% of the anticipated duration of monthly CGRP MAb therapy.

Sustained efficacy of atogepant reported up to 1 year
Once daily atogepant administered over 52 weeks reduced monthly migraine days (MMDs), moderate/severe headache days, and acute medication use days in patients with episodic migraine, with MMD response rates rising during the study.

Growing evidence for benefits of CGRP MAb/onabotulinumtoxinA combination
Further evidence supports the efficacy and safety of combining anti-CGRP therapy with onabotulinumtoxinA. A retrospective, longitudinal chart review was carried out for 149 adult patients with chronic migraine treated with ≥2 consecutive cycles of onabotulinumtoxinA before ≥1 month of onabotulinumtoxinA and CGRP mAb combination treatment.

Fremanezumab lacks efficacy in established post-traumatic headache
No numerical or statistical differences between fremanezumab 675 mg/month and placebo were found in efficacy endpoints in a Phase 2 trial of patients with an established pattern of post-traumatic headache (PTH).¹

App-based study supports real world effectiveness of ubrogepant
Interim findings from a novel, app-based study have supported the real-world effectiveness of ubrogepant 50mg or 100 mg in combination with onabotulinumtoxinA (ubro+onabotA) or CGRP MAb treatment (ubro+MAb) or both (ubro+both) for the acute treatment of migraine. Over 30 days, study assessments were self-reported in an electronic diary format and collected via the Migraine Buddy app. These included meaningful pain relief (MPR) and time to return to normal function.

For all the other recent migraine news featured on the CGRP Forum, catch up at: News

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