The American Headache Society Position Statement on Integrating New Migraine Treatments Into Clinical Practice

American Headache Society

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In This Article

Emerging Acute Treatments

Emerging agents with novel mechanisms of action that have demonstrated efficacy for the acute treatment of migraine include the small molecule CGRP receptor antagonists, ubrogepant[69–72] and rimegepant,[73–76] and lasmiditan,[77] a selective serotonin (5-HT1F) receptor agonist. Unlike triptans and ergotamine derivatives, these novel treatment options do not result in constriction of blood vessels and may have a special role in patients with cardiovascular contraindications to triptans. These novel agents will almost certainly be more costly to health insurance plans and patients than currently available oral triptans for which generic options are available. Therefore, to achieve cost-effective care while ensuring access to those most appropriate for these treatments, it is important that the indications for initiating treatment with novel acute oral medications, including ubrogepant, rimegepant, and lasmiditan, are widely understood and followed closely.

Patients who have contraindications to the use of triptans or who have failed to respond to or tolerate at least 2 oral triptans, as determined by either a validated acute treatment patient reported outcome questionnaire (eg, Migraine Treatment Optimization Questionnaire [mTOQ], Migraine Assessment of Current Therapy [Migraine-ACT], Patient Perception of Migraine Questionnaire-Revised [PPMQ-R], Functional Impairment Scale [FIS], Patient Global Impression of Change [PGIC]) or healthcare provider attestation, are eligible for ubrogepant, rimegepant, lasmiditan, or a neuromodulation device. Coverage should be provided until at least 2 attacks are treated to determine efficacy and tolerability. Continuation of coverage should be based on the frequency of migraine attacks in an average month and response to a validated acute treatment patient-reported outcome questionnaire or clinical assessment of improvement by the healthcare provider.

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