MIGRAINE AWARENESS AND PREVENTION
Date: 11/01/23
Migraines are a neurological disorder characterized initially by a unilateral headache accompanied by nausea and/or photo, sound, or odor sensitivity.1 Migraines are three times more prevalent in women than they are in men.2 Currently, there are 39 million people in the United States diagnosed with migraines.3 There are a number of known factors that can trigger migraines such as menstruation, dehydration, food smells, stress, alcohol, or sleep schedule changes.3,4
Migraines occur in four clinical phases: prodrome, aura, headache, and postdrome.3,4
- Prodrome (preheadache)- occurs 24-48 hours prior to the migraine, and in some cases it can last several days prior to the migraine. The patient may notice changes such as mood changes, food cravings, problems concentrating, or increased urination.
- Aura-Experienced by approximately 25% of migraine patients. Can last from five to 60 minutes. It can occur before or during the migraine. The patient may experience visual or auditory disturbances, or nausea.
- Headache- Untreated, a migraine can last from four- 72 hours. Patient may experience a throbbing head pain, photosensitivity, nausea or vomiting.
- Postdrome (migraine hangover)- Occurs for one to two days after the migraine. The patient may feel confused or fatigue. Some patients report feeling a euphoria.
Treatment
The treatment plan should include education for the patient regarding avoidance of triggers and symptom management. Patients should also be encouraged to keep a migraine journal to track migraine episodes, symptoms, and triggers.
Abortive Treatment5
Non-pharmacological therapy includes having the patient go to a darkened room, increase fluids, limit caffeine intake, placing a cool cloth on the forehead, and yoga. For mild pain, acetaminophen or non-steroidal anti-inflammatory drugs can be given. For more moderate to severe pain, a triptan or calcitonin gene-related peptide (CGRP) inhibitor can be considered. For patients with nausea or vomiting as part of their symptoms, an antiemetic can be prescribed.
Preventative6
Patients with episodic migraines (<15 headaches/month) for 3 months) can be prescribed amitriptyline, venlafaxine, propranolol or topiramate to prevent migraines from occurring. If the patient has a contraindication or inadequate response to the above agents then CGRP inhibitors, valproate, or gabapentin can be considered.
Preventative therapy for chronic migraines (≥15 headaches/month) is similar. Propranolol, amitriptyline, topiramate and valproic acid. If the patient has a contraindication or inadequate response to the above agents then Botox, CGRP inhibitors, verapamil, gabapentin, or other tricyclic antidepressants can be considered.
Meridian Preferred Migraine Products
Drug | Status |
|---|---|
Rizatriptan (Tabs/ODT) | Preferred |
Sumatriptan | Preferred |
Qulipta® | Preferred with Prior Authorization |
Aimovig® | Preferred with Prior Authorization |
Ajovy® | Preferred with Prior Authorization |
Nurtec® | Preferred with Prior Authorization |
Emgality® | Preferred with Prior Authorization |
References
1. Migraine. Accessed September 12, 2023.
2. Migraine Headaches. Accessed September 12, 2023.
3. Types of Migraines. Accessed September 12, 2023.
4. Cutrer, F Michael. Pathophysiology, clinical manifestations, and diagnosis of migraine in adults. Accessed September 12, 2023.
5. Schwedt, TJ. Acute treatment of migraine in adults. Accessed September 12, 2023.
6. Schwedt, TJ. Preventive treatment of episodic migraine in adults. Accessed September 12, 2023.