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. 2025 Feb;45(2):3331024251320608.
doi: 10.1177/03331024251320608.

Setting higher standards for migraine prevention: A position statement of the International Headache Society

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Free article

Setting higher standards for migraine prevention: A position statement of the International Headache Society

Simona Sacco et al. Cephalalgia. 2025 Feb.
Free article

Abstract

Migraine is one of the most prevalent and disabling neurological diseases, significantly affecting quality of life and productivity, as well as contributing to substantial societal costs. Recent innovations, including calcitonin gene-related peptide (CGRP) pathway inhibitors and onabotulinumtoxinA, have transformed migraine prevention by offering high efficacy and excellent tolerability, thus improving adherence. Clinical trials and real-world studies show that significant reductions in migraine frequency and, in some cases, complete migraine freedom is achievable. In this Position Statement, we advocate for raising the standards of migraine prevention by setting ambitious treatment goals aimed at optimal outcomes, such as migraine freedom or very low number of days with migraine or moderate/severe headache. We emphasize the importance of addressing residual migraine burden, highlighting that achieving a ≥50% reduction in monthly migraine days, although often considered a successful response, may not fully restore quality of life. Relying solely on percentage-based improvements can obscure the persisting impact of residual burden. This Position Statement does not want to change the standards for clinical trials but aims primarily at real-world clinical practice and proposes a shift from percentage-based measures of success to absolute goals while on treatment. We outline a framework that categorizes outcomes into four tiers: migraine freedom (no days with migraine or moderate-to-severe headache), optimal control (less than four days with migraine or moderate-to-severe headache), modest control (four to six days with migraine or moderate-to-severe headache) and insufficient control (more than days with migraine or moderate-to-severe headache). Focusing on residual burden while on treatment aims to further improve patient quality of life and drive innovation in preventive therapies and non-pharmacological approaches. By advocating for higher standards, this Position Statement, is not aimed primarily to drive reimbursement policies for migraine preventive treatments, but seeks to inspire clinicians, researchers and policymakers to prioritize ambitious goals in migraine prevention, ultimately enhancing patient outcomes and reducing the broader societal and economic impact of this debilitating condition.

Keywords: CGRP; chronic migraine; gepant; migraine; monoclonal antibodies; prevention.

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Conflict of interest statement

Declaration of conflicting interestsSimona Sacco has received personal fees as speaker or advisor from Abbott, Allergan-Abbvie, AstraZeneca, Bayer, Boheringer, Eli Lilly, Lundbeck, Novartis, NovoNordisk, Pfizer and Teva, as well as research grants from Novartis, Uriach. She is president elect European Stroke Organisation, editor-in-chief of Cephalalgia and Cephalalgia Reports, and assistant editor for Stroke.Messoud Ashina reports receiving personal fees as speaker or consultant from AbbVie, Amgen, Astra Zeneca, Eli Lilly, GlaxoSmithKline, Lundbeck, Novartis, Pfizer and Teva. MA reports research support from Lundbeck Foundation, Novo Nordisk Foundation, Novartis and Lundbeck (all to institution). MA also reports serving as an Associate Editor of Brain and The Journal of Headache and Pain.Hans-Christoph Diener received honoraria for participation in clinical trials, contribution to advisory boards or oral presentations from: AbbVie, Lundbeck, Teva and WebMD. The German Research Council (DFG) supports headache research by HCD. HCD serves on the editorial boards of Cephalalgia, Lancet Neurology and Drugs.Faraidoon Haghdoost declares no conflict of interest.Mi Ji Lee has received personal fees as speaker or advisor from Abbvie, Eli Lilly, Lundbeck, Pfizer, Teva, Organon, CKD, SK Chemical, YuYu and NuEyne; research support from Abbvie, Pfizer, Eli Lilly, Pfizer, Lundbeck, Novartis, Teva, Otsuka, BioHaven, Ildong, Yuhan, NuEyne, Teva and YuYu; as well as research grants from National Research Foundation of Korea (NRF), Medical Device Development Fund grant funded by the Korea government, Korean Headache Society and Seoul National University. She is an associate editor for Cephalalgia and Headache and Pain Reports.Teshamae S. Monteith has the following disclosures over the past three years: clinical trial site principal investigator for studies sponsored by Eli Lilly and AbbVie (all paid to the institution); participation in an advisory board/consultancy for AbbVie, Teva, Linpharma, e-Neura, Novartis, Merz, Lundbeck and Pfizer; Educational grant from Amgen and AbbVie; personal fees from Medscape, Massachusetts Medical Society, American Headache Society, American Academy of Neurology, Neurodiem, Academic CME, AbbVie and Novartis; and unpaid co-author for research funded by AbbVie, Pfizer/Biohaven and Theranica. She is an associate editor for Cephalalgia and Continuum Audio, deputy editor for Neurology Minute, and is on the editorial board for Neurology, American Migraine Foundation and Brain and Life Magazine. TSM has provided unpaid service on the board of directors for the International Headache Society (2021–2023) and is currently on the executive board for the Florida Society of Neurology.Bronwyn Jenkins has received personal fees as speaker, advisor or to attend a conference from Allergan-Abbvie, Care Pharmacy, Eli Lilly, Lundbeck, Novartis, Pfizer and Teva. She is immediate past president of the Australian and New Zealand Headache Society, an associate editor of Cephalalgia and is on the subcommittees for education and ethics of the International Headache Society.Mario F. P. Peres has received honoraria as a consultant and speaker from Ache, Allergan-AbbVie, Eli-Lilly, Eurofarma, Libbs, Lundbeck, Novartis, Pfizer, Sanofi and Teva. He is President-Elect of the International Headache Society.Patricia Pozo-Rosich, within the prior 36 months, has received honoraria as a consultant and speaker from AbbVie, Dr Reddy's, Eli Lilly, Lundbeck, Medscape, Novartis, Organon, Pfizer and Teva Pharmaceuticals. Her research group has received research grants from AbbVie, AGAUR, EraNet Neuron, FEDER RIS3CAT, Instituto Investigación Carlos III, MICINN, Novartis and Teva Pharmaceuticals, and has received funding for clinical trials from AbbVie, Amgen, Biohaven, Eli Lilly, Lundbeck, Novartis, Pfizer and Teva Pharmaceuticals. She is the Honorary Secretary of the International Headache Society, is on the editorial board of Revista de Neurologia, is an associate editor for Cephalalgia, Headache, Neurologia and Frontiers of Neurology, and is an advisor of the Scientific Committee of the Editorial Board of The Journal of Headache and Pain. She is a member of the Clinical Trials Guidelines Committee and Scientific Committee of the International Headache Society. She has edited the Guidelines for the Diagnosis and Treatment of Headache of the Spanish Neurological Society. She is the founder of www.midolordecabeza.org.Raffaele Ornello reports personal fees and non-financial support from AbbVie, Eli Lilly, Lundbeck, Novartis, Pfizer and Teva. He has received research funding from the Italian Ministry of Health. He is Editorial Board Member for The Journal of Headache and Pain.Francesca Puledda has received speaker honoraria from TEVA and Abbvie and serves on the editorial boards of Cephalalgia and The Journal of Headache and Pain.Fumihiko Sakai has received honoraria as a consultant and speaker from AbbVie, Eli Lilly, Otsuka, Amgen and Daiichi-Sankyo Pharmaceuticals.Todd Schwedt, within the prior 24 months, has received consulting fees from AbbVie, Allergna, Amgen, Linpharma, Lundbeck, Salvia BioElectronics and Scilex, as well as royalties from UpToDate. He holds/held stock options in Aural Analytics and Nocira. He has received research funding from the American Heart Association, Flinn Foundation, Henry Jackson Foundation, National Headache Foundation, National Institutes of Health, Patient Centered Outcomes Research Institute, Pfizer, Spark Neuro and United States Department of Defense.Gisela Terwindt reports consultancy or industry support from Novartis, Lilly and Teva, Allergan/Abbvie, Lundbeck, Pfizer and Interactive Studios, as well as independent support from the European Community, Dutch Heart Foundation, Dutch Research Council, Dutch Brain Foundation and Dioraphte.Gloria Vaghi has received personal fees for participating in speaking at scientific events from Lundbeck.Shuu-Jiun Wang has served on the advisory boards of Taiwan Pfizer, AbbVie and Hava-Biopharma; has received honoraria as a moderator from AbbVie, Pfizer and Biogen; and has been the principal investigator in clinical trials sponsored by AbbVie, Novartis, Lundbeck and Pfizer. He has received research grants from the National Council of Technology and Science of Taiwan, Brain Research Center, National Yang Ming Chiao Tung University from The Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan, Taipei Veterans General Hospital, and Taiwan branches of Eli Lilly and Novartis.Fayyaz Ahmed received honoraria for being on the advisory board of Abbvie Novartis Lundbeck Eli Lilly Teva organon Dr Reddy and Pfizer. Recipient of service improvement grant from Pfizer.Cristina Tassorelli received personal fees for participating in advisory boards or for lecturing at sponsored symposia for AbbVie, Dompé, Eli Lilly, Ipsen, Lundbeck, Medscape, Pfizer and Teva. She is principal investigator or collaborator in clinical trials sponsored by AbbVie, Eli Lilly, Ipsen, Lundbeck, Pfizer and Teva. She has received research grants from the European Commission, the Italian Ministry of Health, the Italian Ministry of University, the Migraine Research Foundation and the Italian Multiple Sclerosis Foundation.

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