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AAN 2022 | How to sequence treatments in migraine

Jessica Ailani, MD, MedStar Georgetown University Hospital, Georgetown, Washington, DC, talks on acute and preventative treatment sequencing in headache. For treatment-naïve patients who present no contraindications, the standard acute treatment is a triptan, thought to be safer in cases of pregnancy than the newer gepant category of therapies. If the patient experiences side effects or minimal efficacy, the next treatment option is newer medication, such as a gepant or ditan, depending on the migraine type and patient preference. For migraine prevention, the calcitonin gene-related peptides (CGRP) category is recommended after trying at least two generic oral agents and monitoring efficacy, as these have more long-term efficacy and safety data and are easier to stop than injectable treatments. This interview took place at the American Academy of Neurology 2022 Congress in Seattle, WA.