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EAN 2021 | An adaptive approach is critical for successful long-term preventive migraine treatment

The aggressiveness of a patient’s migraine does not remain constant over time; rather, it goes through phases of differing frequency and severity. Zaza Katsarava, MD, PhD, MSc, University of Essen, Essen, Germany, discusses the importance of reflecting these changes with an adaptive treatment approach. After 6-12 months of treatment, a patient should be reviewed to determine the best way to move forward. Some patients will still have active migraine requiring continued treatment, while others may have shown significant improvement. In this case, treatment should be paused and outcomes monitored. This interview took place during the European Academy of Neurology 2021 congress.

Transcript (edited for clarity)

Migraine is an oscillating disease, so it’s not constant. So there are phases in life of patients where the migraine is more aggressive and increases in frequency and then decreases spontaneously. So our treatment should be adapted to the different phases in the life of patients. And if migraine is more active, we should be more active and sometimes we improve the situation and then we should go back...

Migraine is an oscillating disease, so it’s not constant. So there are phases in life of patients where the migraine is more aggressive and increases in frequency and then decreases spontaneously. So our treatment should be adapted to the different phases in the life of patients. And if migraine is more active, we should be more active and sometimes we improve the situation and then we should go back. That’s why it’s common sense that migraine prevention should be given for six months, nine months or twelve month. And then the indication for migraine prevention should be at least reevaluated.

In some patients, we’ll find that we could improve it a bit, but migraine is still active. Then we should continue preventative medication. In some patients, migraine improves drastically. So improvement is really significant. So in these patients, we can stop and wait and see. In many patients we achieve stability, we achieve a remission and then nothing else is necessary. But in other patients, we start preventative medication, but we cannot improve it. And then it’s necessary to realize that and to escalate the treatment, to change the medication or add another medication. So this is nothing constant in that we try to adapt our treatment to the needs of patients individually.

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Disclosures

Prof. Katsarava has received honoraria from Allergan, Lilly, Novartis and TEVA.