PMID- 36920123
OWN - NLM
STAT- MEDLINE
DCOM- 20230418
LR  - 20230601
IS  - 1526-4610 (Electronic)
IS  - 0017-8748 (Linking)
VI  - 63
IP  - 4
DP  - 2023 Apr
TI  - Expert consensus established around flexible, individualized migraine treatment 
      utilizing a modified Delphi panel.
PG  - 506-516
LID - 10.1111/head.14479 [doi]
AB  - OBJECTIVE: To characterize treatment decision-making processes and formalize 
      consensus regarding key factors headache specialists consider in treatment 
      decisions for patients with migraine, considering novel therapies. BACKGROUND: 
      Migraine therapies have long been subject to binary classification, acute versus 
      preventive, due to limitations of available drugs. The emergence of novel 
      therapies that can be used more flexibly creates an opportunity to rethink this 
      binary classification. To determine the role of these novel therapies in 
      treatment, it is critical to understand whether existing guidelines reflect 
      clinical practice and to establish consensus around factors driving management. 
      METHODS: A three-round modified Delphi process was conducted with migraine 
      clinical experts. Round 1 consisted of an online questionnaire; Round 2 involved 
      an online discussion of aggregated Round 1 results; and Round 3 allowed 
      participants to revise Round 1 responses, incorporating Round 2 insights. 
      Questions elicited likelihood ratings (0 = highly unlikely to 100 = highly 
      likely), rankings, and estimates on treatment decision-making. RESULTS: Nineteen 
      experts completed three Delphi rounds. Experts strongly agreed on definitions for 
      "acute" (median = 100, inter-quartile range [IQR] = 5) and "preventive" treatment 
      (median = 90, IQR = 15), but noted a need for treatment customization for 
      patients (median = 100, IQR = 6). Experts noted certain aspects of guidelines may 
      no longer apply based on established tolerability and efficacy of newer acute and 
      preventive agents (median = 91, IQR = 17). Further, experts agreed on a treatment 
      category referred to as "situational prevention" (or "short-term prevention") for 
      patients with reliable and predictable migraine triggers (median = 100, IQR = 10) 
      or time-limited periods when headache avoidance is important (median = 100, 
      IQR = 12). CONCLUSIONS: Using the modified Delphi method, a panel of migraine 
      experts identified the importance of customizing treatment for people with 
      migraine and the utility of "situational prevention," given the ability of new 
      treatment options to meet this need and the potential to clinically identify 
      patients and time periods when this approach would add value.
CI  - (c) 2023 Biohaven Pharmaceuticals. Headache: The Journal of Head and Face Pain 
      published by Wiley Periodicals LLC on behalf of American Headache Society.
FAU - Graf, Marlon
AU  - Graf M
AUID- ORCID: 0000-0002-6240-8867
AD  - PRECISIONheor, Bethesda, Maryland, USA.
FAU - Kim, Edward
AU  - Kim E
AD  - Biohaven Pharmaceuticals, Inc, New Haven, Connecticut, USA.
FAU - Brewer, Iris
AU  - Brewer I
AD  - PRECISIONheor, Bethesda, Maryland, USA.
FAU - Hernandez, Jennifer
AU  - Hernandez J
AD  - PRECISIONheor, Bethesda, Maryland, USA.
FAU - Chou, Jacquelyn W
AU  - Chou JW
AD  - PRECISIONheor, Bethesda, Maryland, USA.
FAU - Cirillo, Jessica
AU  - Cirillo J
AD  - Biohaven Pharmaceuticals, Inc, New Haven, Connecticut, USA.
FAU - Jensen, Christopher
AU  - Jensen C
AD  - Biohaven Pharmaceuticals, Inc, New Haven, Connecticut, USA.
FAU - Lipton, Richard
AU  - Lipton R
AD  - Albert Einstein College of Medicine, Bronx, New York, USA.
LA  - eng
GR  - Biohaven Pharmaceuticals, Inc/
PT  - Journal Article
DEP - 20230315
PL  - United States
TA  - Headache
JT  - Headache
JID - 2985091R
SB  - IM
MH  - Humans
MH  - Consensus
MH  - *Migraine Disorders/drug therapy
MH  - Delphi Technique
MH  - Surveys and Questionnaires
MH  - Headache
OTO - NOTNLM
OT  - acute migraine therapy
OT  - migraine
OT  - migraine impact
OT  - outcomes research
OT  - prophylactic/preventive treatment
EDAT- 2023/03/16 06:00
MHDA- 2023/04/18 06:42
CRDT- 2023/03/15 09:33
PHST- 2022/11/29 00:00 [revised]
PHST- 2022/09/27 00:00 [received]
PHST- 2022/12/14 00:00 [accepted]
PHST- 2023/04/18 06:42 [medline]
PHST- 2023/03/16 06:00 [pubmed]
PHST- 2023/03/15 09:33 [entrez]
AID - 10.1111/head.14479 [doi]
PST - ppublish
SO  - Headache. 2023 Apr;63(4):506-516. doi: 10.1111/head.14479. Epub 2023 Mar 15.