Multimodal Migraine Management and the Pursuit of Migraine Freedom: A Narrative Review
Abstract Migraine is a neurologic disease with a complex pathophysiology that can be controlled with current treatment options but not cured. Therefore, treatment expectations are highly variable. The concept of migraine freedom was recently introduced and can mean different things, with some, for e...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Adis, Springer Healthcare
2023-08-01
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| Series: | Neurology and Therapy |
| Subjects: | |
| Online Access: | https://doi.org/10.1007/s40120-023-00529-x |
| _version_ | 1797736429475856384 |
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| author | Andrew M. Blumenfeld Richard B. Lipton Stephen Silberstein Stewart J. Tepper Larry Charleston Stephen Landy Deena E. Kuruvilla Aubrey Manack Adams |
| author_facet | Andrew M. Blumenfeld Richard B. Lipton Stephen Silberstein Stewart J. Tepper Larry Charleston Stephen Landy Deena E. Kuruvilla Aubrey Manack Adams |
| author_sort | Andrew M. Blumenfeld |
| collection | DOAJ |
| description | Abstract Migraine is a neurologic disease with a complex pathophysiology that can be controlled with current treatment options but not cured. Therefore, treatment expectations are highly variable. The concept of migraine freedom was recently introduced and can mean different things, with some, for example, expecting complete freedom from headache and associated symptoms and others accepting the occasional migraine attack if it does not impact functioning. Therefore, migraine management should be optimized so that patients can have the best opportunity to achieve their optimal treatment goals. With migraine freedom as a goal and, given the complex pathophysiology of migraine and the high incidence of comorbidities among individuals with migraine, treatment with a single modality may be insufficient, as it may not achieve migraine freedom in those with more frequent or disabling attacks. In this clinical perspective article, we have identified four key, partially overlapping principles of multimodal migraine treatment: (1) manage common comorbidities; (2) control modifiable risk factors for progression by addressing medication and caffeine overuse; (3) diagnose and treat secondary causes of headache, if present; and (4) individualize acute and preventive treatments to minimize pain, functional disability, and allodynia. There are many barriers to pursuing migraine freedom, and strategies to overcome them should be optimized. Migraine freedom should be an aspirational goal both at the individual attack level and for the disease overall. We believe that a comprehensive and multimodal approach that addresses all barriers people with migraine face could move patients closer to migraine freedom. |
| first_indexed | 2024-03-12T13:12:41Z |
| format | Article |
| id | doaj.art-bb3f6e1700ef433e92ce463429385b39 |
| institution | Directory Open Access Journal |
| issn | 2193-8253 2193-6536 |
| language | English |
| last_indexed | 2024-03-12T13:12:41Z |
| publishDate | 2023-08-01 |
| publisher | Adis, Springer Healthcare |
| record_format | Article |
| series | Neurology and Therapy |
| spelling | doaj.art-bb3f6e1700ef433e92ce463429385b392023-08-27T11:32:22ZengAdis, Springer HealthcareNeurology and Therapy2193-82532193-65362023-08-011251533155110.1007/s40120-023-00529-xMultimodal Migraine Management and the Pursuit of Migraine Freedom: A Narrative ReviewAndrew M. Blumenfeld0Richard B. Lipton1Stephen Silberstein2Stewart J. Tepper3Larry Charleston4Stephen Landy5Deena E. Kuruvilla6Aubrey Manack Adams7The Los Angeles and San Diego Headache CentersAlbert Einstein College of MedicineDepartment of Neurology, Thomas Jefferson UniversityNew England Institute for Neurology and HeadacheDepartment of Neurology and Ophthalmology, Michigan State University College of Human MedicineTupelo Headache ClinicWestport Headache InstituteAbbVieAbstract Migraine is a neurologic disease with a complex pathophysiology that can be controlled with current treatment options but not cured. Therefore, treatment expectations are highly variable. The concept of migraine freedom was recently introduced and can mean different things, with some, for example, expecting complete freedom from headache and associated symptoms and others accepting the occasional migraine attack if it does not impact functioning. Therefore, migraine management should be optimized so that patients can have the best opportunity to achieve their optimal treatment goals. With migraine freedom as a goal and, given the complex pathophysiology of migraine and the high incidence of comorbidities among individuals with migraine, treatment with a single modality may be insufficient, as it may not achieve migraine freedom in those with more frequent or disabling attacks. In this clinical perspective article, we have identified four key, partially overlapping principles of multimodal migraine treatment: (1) manage common comorbidities; (2) control modifiable risk factors for progression by addressing medication and caffeine overuse; (3) diagnose and treat secondary causes of headache, if present; and (4) individualize acute and preventive treatments to minimize pain, functional disability, and allodynia. There are many barriers to pursuing migraine freedom, and strategies to overcome them should be optimized. Migraine freedom should be an aspirational goal both at the individual attack level and for the disease overall. We believe that a comprehensive and multimodal approach that addresses all barriers people with migraine face could move patients closer to migraine freedom.https://doi.org/10.1007/s40120-023-00529-xDrug targetingExpert opinionsMigraine disordersMultimodal treatment |
| spellingShingle | Andrew M. Blumenfeld Richard B. Lipton Stephen Silberstein Stewart J. Tepper Larry Charleston Stephen Landy Deena E. Kuruvilla Aubrey Manack Adams Multimodal Migraine Management and the Pursuit of Migraine Freedom: A Narrative Review Neurology and Therapy Drug targeting Expert opinions Migraine disorders Multimodal treatment |
| title | Multimodal Migraine Management and the Pursuit of Migraine Freedom: A Narrative Review |
| title_full | Multimodal Migraine Management and the Pursuit of Migraine Freedom: A Narrative Review |
| title_fullStr | Multimodal Migraine Management and the Pursuit of Migraine Freedom: A Narrative Review |
| title_full_unstemmed | Multimodal Migraine Management and the Pursuit of Migraine Freedom: A Narrative Review |
| title_short | Multimodal Migraine Management and the Pursuit of Migraine Freedom: A Narrative Review |
| title_sort | multimodal migraine management and the pursuit of migraine freedom a narrative review |
| topic | Drug targeting Expert opinions Migraine disorders Multimodal treatment |
| url | https://doi.org/10.1007/s40120-023-00529-x |
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