The George Institute welcomes new international push to raise the bar in migraine

The George Institute for Global Health welcomes new migraine treatment recommendation that suggests raising the target reduction of migraine days from the current standard of 50% to 90-100%.¹

If adopted, the new four-level framework for assessing migraine control in the ‘Setting higher standards for migraine prevention’ position statement from The International Headache Society (IHS), published in Cephalalgia, has the potential to improve the lives of millions of Australians impacted by migraine.

The IHS advocates the higher goals based on the positive impact of new treatment advancements such as calcitonin gene-related peptide (CGRP) pathway inhibitors introduced in the past decade, as well as other agents showing strong results in clinical trials.

In Australia, around 4.9 million people live with migraine, with 86% of them being of working age.² Women represent 72% of those affected, with migraine impacting fertility and family planning, and causing stigma that can impact their career growth and mental health.^3,4 The total economic cost of migraine in Australia is estimated at $35.7 billion per year.⁵

“

It was time for new recommendations that will bring us closer to managing migraine as a disease that can be controlled in a similar way to epilepsy, multiple sclerosis and other chronic conditions.

The consistency of new agents in multiple clinical trials and real-world studies to achieve effective and sustained migraine prevention, means we can offer more hope for eliminating disability from migraine and for sufferers to be able to live free from constant worry about the next attack, the debilitating pain, and the frustration of not being taken seriously

By: Dr Faraidoon HaghdoostResearch Fellow in headache disorders at The George Institute for Global Health, Conjoint Lecturer at UNSW Sydney, and one of the contributors to the IHS Position Statement.

Traditionally, a 50% reduction in migraine days per month - or even 30% reduction for those with chronic or harder-to-treat symptoms - was the benchmark for a successful response to therapies. But in the real world, this translates to many days still impacted by migraine, with fear of future episodes making life planning difficult even on pain-free days.

“

While a 50% reduction in headache days is considered a significant and positive outcome of treatment, it shouldn't be seen as the final goal, since many patients still face a substantial burden even after reaching this threshold.

We can now strive for much better results through personalised treatment, whether that's combination therapy or using the new agents. The recommendations from the IHS encourage clinicians to make ongoing efforts to further reduce headache frequency and improve quality of life, rather than settling for a predefined reduction target.

By: Dr Faraidoon Haghdoost

The IHS recommendations introduce a new four-level framework for assessing migraine control:

1. Migraine freedom - No days with migraine or moderate-to-severe headache
2. Optimal control - Fewer than four days per month with migraine or moderate-to-severe headache
3. Modest control - Between four and six days per month with migraine or moderate-to-severe headache
4. Insufficient control - More than six days per month with migraine or moderate-to-severe headache

In Australia, patients need to record at least 15 headache days per month to qualify for PBS reimbursement of the newer therapies.

“

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.

By: Dr Faraidoon Haghdoost

Read the full Position Statement.