New Migraine Treatments Health Execs Should Watch

Nicole Hahn, PharmD, BCACP

Migraines are debilitating and costly-both to patients in lost wages and treatment, and to healthcare as a whole.

But new treatments and technologies can help. That’s according to Machaon Bonafede, PhD, MPH, senior director of outcomes research at IBM Watson Health, and Nicole Hahn, PharmD, BCACP, clinical pharmacy specialist in neurology at Kaiser Permanente Colorado. The two delivered a presentation titled, "Developments in migraine treatment and management," October 23 at the Academy of Managed Care Pharmacy Nexus 2018 in Orlando.

There are a number of new innovations in the works that may drastically improve migraine management. Hahn highlighted those therapies for Managed Healthcare Executive (MHE).

MHE: Migraines don’t often come to mind as a top health issue. What is your goal in highlighting this condition at AMCP Nexus?

Hahn: Migraines seem to be a very hot topic right now, especially with three medications approved for preventing migraines. They all belong to a new class of medications with a novel mechanism. My copresenter, Machaon Bonafede, and I hope listeners will learn more about these new medications, including their efficacy and safety as well as recognize the economic and quality of life impact of chronic migraine sufferer. We will be able to discuss the current health economics and outcomes, as well as available research data for chronic migraine.

MHE: An impaired quality of life is understandable, but please expand on this. A migraine isn’t just the occasional headache, right?

Hahn: A migraine is a type of headache where people experience a pulsating, throbbing pain, and it is accompanied by other symptoms such as nausea and/or vomiting and sensitivity to light, noise, and/or smells. If migraines are severe enough, they can disrupt daily activities (work, school, home, etc.) as patients often have to retreat to a cold, dark, quiet room until the pain subsides. Migraines can occur at different frequencies depending on the patient. For example, some migraine patients only have a migraine once a year-some more infrequent than that, while others can suffer from migraine attacks more than half of the days every month-that level of frequency will likely be diagnosed as having chronic migraines.

MHE: We typically don’t think of migraines as a costly condition. Please tell us a little about the economic impact of migraine management for patients and managed care providers/payers.

Hahn: Patients with frequent migraine headaches or migraine headaches that do not respond to medications increase utilization of healthcare services, such as office visits, urgent care visits, and ED visits.

MHE: Please discuss the current top treatments, as well as some new therapies and how they might improve both cost and quality of life. 

Hahn: Before these medications in this new “CGRP” class were approved, we most often utilized therapies such as certain anti-hypertensives, anticonvulsants, antidepressants, onabotulinumtoxinA, and some over-the-counter products as a way to reduce the number of migraines a patient was experiencing. These are also considered to be preventive therapy options. Choice of which option to try often depends on the patients’ other medical conditions, risk of side effects, as well as level of evidence. The new CGRP therapies provide a novel, migraine-specific mechanism with effective results. Currently approved treatments are erenumab, galcanezumab, and fremanezumab. As with currently approved preventive options, CGRP’s don’t improve migraines for everyone who takes them, and there are some lingering questions on the safety of using these medications in certain patient populations. I think we’ll have to wait and see how and if these medications improve both cost and quality of life.