Episodic and Chronic Migraine: New Preventive Treatment CE for Nurse Practitioners

CGRP in Migraine

June is National Migraine and Headache Awareness Month, and the American Association of Nurse Practitioners® (AANP) is joining in to increase awareness of these neurological diseases and share new treatment options.

Migraine is a common, sometimes debilitating, neurological disorder — yet there are methods for prevention.

According to the Migraine Research Foundation, 39 million men, women and children in the U.S. experience migraines. While migraines are most common in individuals between the ages of 18 and 44, they are often undiagnosed in children and disproportionately affect women. In fact, 85% of chronic migraine sufferers are women, and roughly one in four women will experience migraine sometime in their lifetime.

Migraine is much more than a bad headache. Data from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) 1990-2016 studies was analyzed, and it was found “that headache, and in particular, migraine, is one of the main causes of disability worldwide, particularly in young adult and middle-aged women.” Headaches and migraine account for about 3% of all emergency department (ED) visits each year. Though guidelines recommend nonopioid treatments for acute migraine, opioids prescribed in the ED to treat headache and migraine have been associated with increased risk of revisits and hospital admissions and increased length of stay.

Medication overuse is the No. 1 reason episodic migraines become chronic. Both episodic and chronic migraines are managed with acute and preventive medications. Frequently, however, acute medications are overused while preventive medications are underused.

In a 2016 real-world analysis of people who suffer from migraine, only 40% reported consulting with a health care provider about their headaches. Just 24.6% received an accurate diagnosis and, of those individuals, 44% received the recommended acute and preventive pharmacologic treatments.

The low rate of preventive medication use may be attributable to the perception that preventive migraine therapies are ineffective. In a survey of primary care providers, 53% reported that they do not prescribe preventive medications because of a perceived lack of effectiveness. Until recently, this perception was borne out by evidence: 86% of patients with migraine discontinued oral migraine preventive medication within one year due to lack of effectiveness or adverse events.

In the past year, a new class of migraine-preventive drugs has reached the market. These agents inhibit calcitonin gene-related peptide (CGRP) and were the first drugs approved that were designed to treat migraines. While standard prophylactic migraine medications, such as antiepileptics or antidepressants, are indicated for other conditions, the CGRP inhibitors are specific to migraine and have been associated with fewer off-target effects.

These agents are poised to change the paradigm of migraine management. Yet, according to a national survey conducted in 2018, only one-third of patients with migraine were aware of CGRP inhibitors. This potentially reflects a lack of health care provider-led discussion of these drugs in clinical practice.

This June, nurse practitioners (NPs) can recognize National Migraine and Headache Awareness Month by discussing headache and migraine with patients. Download free resources from AANP to share with patients, including tri-fold table tents, a patient migraine diary, health care provider flip charts and other patient education tools.

Are You Prepared to Discuss CGRP Inhibitors With Your Patients With Migraine?

AANP is excited to bring NPs a new continuing education (CE) activity on migraine: The Role of CGRP in Migraine (1.0 contact hour of CE, 0.5 of which may be applied toward pharmacology). This activity is designed to educate NPs about migraine diagnosis, pathophysiology and the role of CGRP inhibitors in migraine treatment. Learners will also assess the clinical efficacy and safety data surrounding new and emerging CGRP-targeted therapies.

See This CE Activity