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International calls for migraine management overhaul
A proposed new framework outlines a path to raise the standard of care and includes broader access to newer medications.
The proposed new migraine framework calls for the coupling of pharmaceuticals with pain science education.
The International Headache Society (IHS) has called for the adoption of a new four-level framework, which it says can drastically improve migraine management for patients and GPs.
The proposed framework, released last month, outlines a path to raise the standard of care and includes broader access to newer medications.
The HIS position statement separates migraine control into four categories based on the number of days with migraine or moderate-to-severe headache:
- Migraine freedom – no days
- Optimal control – less than four days
- Modest control – four to six days
- Insufficient control – more than six days
It also focuses on the number of migraine-affected days while on treatment and encourages clinicians to maximise preventive medications together with evidence-based lifestyle factors.
Where previously a 30% or 50% reduction in migraine days per month has been an accepted measure of treatment success, with new medications enabling even better results, the HIS is calling for the goalposts to be shifted to aim for a 90% reduction.
Dr Adele Stewart, Chair of RACGP Specific Interests Pain Management, told
newsGP recent pharmaceutical innovations, such as calcitonin gene-related peptide (CGRP) inhibitors, have transformed migraine prevention paving the way for further improvements in care.
‘Migraine is a highly disabling neurological disease, significantly impacting quality of life, productivity, and society,’ she said.
‘Clinical trials and real-world studies show that substantial reductions in migraine frequency, and in some cases, complete migraine freedom, are achievable.’
‘This shift prioritises addressing residual burden to enhance patient quality of life and drive innovation in both preventive therapies and non-pharmacological approaches.’
Affecting almost
five million Australians, and costing $35.7 billion per year, migraines disproportionately affects women (71%) and people of working age (86%).
Defined as 15 or more migraines per month, chronic migraine is the most debilitating form of the disease and is experienced by 7.6% of migraine sufferers.
Dr Stewart highlights that chronic migraine is a chronic pain condition, and emphasises that patient education and holistic care are essential in managing all forms of chronic pain.
‘Medication is only one tool especially in this cohort who have failed several previous classes of preventative treatment and often have daily headaches,’ she said.
‘Pain science education is an important intervention in all patients with chronic pain.’
‘Studies highlight the importance of tracking migraine triggers, implementing lifestyle interventions including diet, movement and exercise, hydration and sleep to decrease intensity, frequency, disability and self-efficacy in chronic migraine.’
The George Institute for Global Health’s Dr Faraidoon Haghdoost, a contributor to the HIS position statement, calls for expansion of Pharmaceutical Benefits Scheme (PBS) criteria to enable more Australians to benefit from newer pharmaceutical agents.
‘Expanding the criteria to capture those with fewer than 15 headache days would lead to better results in line with new recommended international practice, and reduce the burden on patients and the healthcare system,’ he said.
Dr Stewart too supports the expansion of PBS criteria, which currently requires 15 headaches per month for PBS reimbursement, to improve access for patients to newer medications.
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