Severe migraine and its control: A proposal for definitions and consequences for care

Currently many patients with severe migraine do not receive appropriate treatment and are never referred to specialist headache centres. On the other hand, specialist headache centres are frequently attended by patients whose migraines could be managed adequately in the community. One reason for this may be the absence of standardised definitions of migraine severity and control and of a treatment algorithm for orientating difficult-to-treat patients to specialist headache centres. Based on a review of the relevant literature and consensus meetings, proposals have been made for these items. We propose that migraine should be considered severe if headache frequency is at least eight migraine days per month or, if headaches are less frequent, the HIT-6 score is >= 60 or >= 50% of headaches require complete interruption of activity. The proposed definition of migraine control is defined on the basis of appropriate response to acute headache therapy and to preventative therapy. A treatment algorithm is proposed to assess migraine control regularly and to adapt therapy accordingly. These proposals may contribute to developing and testing strategies for management of severe disease with appropriate and effective preventive treatment strategies. With the anticipated introduction of new possibilities for migraine prevention in the near future, the time is ripe for a holistic approach to migraine management. (C) 2021 Published by Elsevier Masson SAS.

Automated summary

Many severe migraine patients do not receive appropriate treatment, while specialist headache centres often see patients who could be managed adequately in the community. The absence of standardized definitions for migraine severity and control, as well as a treatment algorithm for difficult-to-treat patients, may contribute to this issue. Proposed definitions and treatment algorithms have been suggested to address this gap and enhance the management of severe migraine.