Migraine Relief: Providing Preventive and Abortive Therapies (Podcast)

Approximately 16% to 20% of women and 6% to 10% of men suffer from migraine. In 2018, a revolutionary class of preventive monoclonal antibodies — the calcitonin gene-related peptide (CGRP) receptor antagonists — was introduced to treat migraine.

“The number of new therapies and medications that have recently emerged for the treatment of migraine is unmatched in all other branches of neurology,” says headache specialist Emad Estemalik, MD, MBA, Section Head of Headache and Facial Pain in Cleveland Clinic’s Neurological Institute. “We have been fortunate to welcome a disproportionate share of new interventions.”

In the latest episode of Cleveland Clinic’s Neuro Pathways podcast, Dr. Estemalik explores the current landscape of preventive and abortive therapies for the management of migraine. He discusses the following:

• What constitutes chronic and episodic migraine
• How preventive monoclonal antibodies act in the calcitonin gene-related peptide receptor
• Delivery methods and potential side effects of CGRP receptor antagonists
• The importance of lifestyle modifications in migraine prevention
• Advancements on the horizon, including research on the pituitary adenylate cyclase-activating peptide (PACAP)

Click the podcast player above to listen to the episode now, or read on for a short edited excerpt. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

This activity has been approved for AMA PRA Category 1 Credit™ and ANCC contact hours. After listening to the podcast, you can claim your credit here.

Excerpt from the podcast

Podcast host Glen Stevens, DO, PhD: If I am a migraine patient and I take abortive medications, how much is too much? When should I be put on one of these newer drugs for migraine prevention?

Dr. Estemalik: There are two components to the answer. The frequency of abortive medication use definitely plays a role. If patients are requiring more than two days a week of some abortive, I think it's time to consider a preventive to reduce the use of abortive medication.

Second, it’s often important to also pinpoint exactly the number of headache days a patient is having. A patient can tell you, “I only have four migraines a month.” If those migraines are not adequately treated and you ask how long the migraines last, the patient may say they last three to four days. At that point the patient is already at 12 to 16 headache days a month.

So while the frequency of abortive medications is critical, so is the number of headache days and the degree of debilitation. We really need to understand how patients’ quality of life is affected. Are they missing out on work, social activities, family activities? It’s a matter of putting all of that in context. And that is where we do a phenomenal job at a place like Cleveland Clinic, where our use of patient-reported outcome measures and questionnaires gives us a much deeper understanding beyond just quantitative assessments.