Use gepants for patients at risk of medication overuse headache or who cannot tolerate triptans.
Preventive therapy choice individualized based on patient factors including reproductive status, cardiovascular risk, and prior response.
CGRP-targeting monoclonal antibodies or oral antagonists may be used for prevention, with ACP reserving them for oral preventive failures.
Monitoring & Follow-up
Monitor for medication overuse headache with frequent acute therapy use except with gepants.
Assess preventive therapy effectiveness by reduction in monthly migraine days (≥50% for episodic, ≥30% for chronic).
Evaluate adverse effects and treatment discontinuation rates, especially with oral preventive medications.
Risks
Triptans contraindicated in patients with cardiovascular disease.
Frequent use of most acute therapies (except gepants) can cause medication overuse headache.
High cost and limited long-term safety data for CGRP-targeting therapies.
Patient & Prescribing Data
Patients with episodic or chronic migraine, including those with prior preventive treatment failure
Erenumab showed 56% achieving ≥50% reduction in monthly migraine days vs 17% with oral preventives; lower discontinuation due to adverse effects (3% vs 23%).
Clinical Best Practices
Tailor treatment to patient-specific factors including headache pattern, comorbidities, reproductive goals, and risk factors.
Address modifiable risk factors such as medication overuse, sleep hygiene, and migraine triggers.
Avoid polypharmacy and consider cost-effectiveness when selecting preventive therapies.
Use gepants for patients at risk of medication overuse headache or with contraindications to triptans.
These 10 metropolitan areas reported population gains and active federal shortage area designations identified in census and health care workforce data.
Online interest in leucovorin, folate products, and acetaminophen-related autism concerns increased markedly in the 2 weeks following the White House announcement.
