Director, Headache Medicine Fellowship Program, Associate Professor, Thomas Jefferson University

Stephanie J. Nahas, MD

"A large part of that is the stigma of the disease, where we tend to minimize and think that it’s not so real. There’s a lot of psychological and behavioral stuff, which is true, but it’s also a real biologic disease that is nobody’s fault.”

A total of 16,789 participants were included in the Chronic Migraine Epidemiology and Outcomes (CaMEO) study, with 39% (n = 6579) experiencing 4 or more monthly headache days (MHDs). Within this group, 80.2% reported never using, 9.8% reported currently using, and 10.1% of patients reported previous but not current use of a daily oral migraine preventive.

Although the majority of those with 4 or more MHDs had never used a preventive, most were interested in trying a pharmaceutical treatment, with greater interest in oral versus injectable options. For the study authors, including Stephanie J. Nahas, MD, the number of eligible patients who hadn’t been placed on a preventive was alarming and highlights a major gap in clinical care for migraine.

Nahas, an associate professor and director of the Headache Medicine Fellowship Program at 

, noted that migraine awareness is still not where it should be among the public and physicians. In an interview with 

she stressed that clinicians play an important role for their patients, helping to reduce stigma and promoting open conversations about diagnosis and treatment options.

Nahas SJ, Buse DC, Hutchinson S, et al. Characterizing preventive treatment gaps in migraine: results from the CaMEO study. Presented at 2021 American Academy of Neurology Annual Meeting; April 17-22. Abstract P10.049

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The associate professor and director of the Headache Medicine Fellowship Program at Thomas Jefferson University discussed the role of clinicians in determining migraine treatment eligibility.

Determining Migraine Treatment Eligibility: Stephanie J. Nahas, MD

"Most of society sees [migraine] as a nuisance—even something that’s the fault of the person who has it. There’s a lot that goes on with the thinking and conceptualization on both the patient and provider side. That’s the foundation we’re left with.”

In an effort to characterize preventive treatment gaps in migraine, Stephanie J. Nahas, MD, and colleagues conducted the Chronic Migraine Epidemiology and Outcomes (CaMEO) study and presented their data at the 

2021 American Academy of Neurology (AAN) Annual Meeting

, April 17-22. In total, 39% of those included in the analytical sample reported suffering 4 or more monthly headache days (MHDs), but 80.2% of this group reported never using a daily oral migraine preventive.

Among those who discontinued prevention with 4 or more MHDs, factors contributing to discontinuation included concerns regarding safety and tolerability in 44.6% of patients and insufficient efficacy in 34.8% of patients. Nahas, associate professor and director of the Headache Fellowship Program at 

, noted that these issues start with the growing number of patients who remain undiagnosed.

Nahas detailed the reasons for the underutilization of preventive migraine treatments among this patient population, while stressing the stigmas from society that push patients away from seeking the medication attention they need.

The associate professor and director of the Headache Medicine Fellowship Program at Thomas Jefferson University discussed the barriers to the use of preventive medicines. 

Underutilization of Preventive Migraine Treatments: Stephanie J. Nahas, MD

"Acute treatments can come in many varieties, and there can be confusion on the part of patients and providers as to what is best to recommend for the patient. We can even take a step back and say that around half of people with migraine aren’t even diagnosed yet.”

The Chronic Migraine Epidemiology and Outcomes (CaMEO) study was conducted by a number of researchers to evaluate the effect of acute treatment optimization in participants with migraine across monthly headache day (MHD) frequency categories. The results, presented at the 

, April 17-22, showed that poor acute treatment optimization was associated with greater lost productive time (LPT).

The relationship was statistically significant for all MHD groups observed, except for those who experienced 8-14 MHDs. Participants experiencing more than 15 MHDs who had poor/very poor acute treatment had a mean increase in 3-month LPT, from 7.1 to 30.5 days. Stephanie J. Nahas, MD, was among the investigators of the study, and claims that although the results may not come as a great surprise, the magnitude of the data was shocking.

Nahas, an associate professor and director of the Headache Medicine Fellowship Program at Thomas Jefferson, sat down with 

to discuss where these issues of poor treatment optimization stem from, along with ways clinicians can better tailor their regimens. This tailoring, she noted, is important in ensuring that patients get the most benefit from their therapy.

Buse D, Nahas SJ, Stewart W, et al. Optimized acute treatment is associated with productivity gains in people with migraine: results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study. Presented at 2021 American Academy of Neurology Annual Meeting; April 17-22. Abstract P10.049

The associate professor and director of the Headache Medicine Fellowship Program at Thomas Jefferson University detailed the ways clinicians can tailor their treatment regimens better. 

 Optimizing Treatment in Acute Migraine: Stephanie J. Nahas, MD

"You want to be conscious of polypharmacy and whether you could run into trouble with these drug-drug interactions, or by making another medical condition worse, which these monoclonal antibodies are unlikely to do.”

Over the past decade migraine specialists have been fortunate to have a toolbox of treatments at their disposal, most notably the anti-calcitonin gene-related peptides (CGRP) inhibitors, a relatively new class of medications. In 2018, the FDA approved the use of fremanezumab, an anti-CGRP inhibitor itself, for the prevention of migraine in adults.

 Since then, there have been a number of studies that have displayed its efficacy in even greater detail.

, April 17-22, Stephanie J. Nahas, MD, presented 2 abstracts that evaluated fremanezumab in this population. The first demonstrated that the treatment is efficacious in both moderate and higher frequency episodic migraine, while the second showed that the drug has a favorable cardiovascular (CV) safety profile in participants with a CV medical history or with multiple CV risk factors.

, feels as though fremanezumab has a lot to offer among a treatment landscape that is ever-growing. She sat down with 

to point out the significant differences in anti-CGRP agents and why the vast collection of data only further strengthens fremanezumab’s case.

1. Teva Announces U.S. Approval of AJOVYTM (fremanezumab-vfrm) Injection, the First and Only Anti-CGRP Treatment with Both Quarterly and Monthly Dosing for the Preventive Treatment of Migraine in Adults. News release. Teva Pharmaceutical Industries Ltd; September 14, 2018. Accessed April 22, 2021. https://www.businesswire.com/news/home/20180914005613/en/Teva-Announces-U.S.-Approval-AJOVYTM-fremanezumab-vfrm-Injection.

2. Nahas S, Ning X, Cohen JM, Barash S, Campos VR, Silberstein SD. Efficacy of fremanezumab in patients with moderate and higher frequency episodic migraine. Presented at 2021 American Academy of Neurology Annual Meeting. Abstract P10.046

3. Nahas S, Jurgens TP, Kessler Y, et al. Cardiovascular safety of fremanezumab in patients with migraine and cardiovascular medical history or risk factors: A pooled analysis of phase 3 studies. Presented at 2021 American Academy of Neurology Annual Meeting. Abstract P10.034

The associate professor and director of the Headache Medicine Fellowship Program at Thomas Jefferson University detailed the reasons fremanezumab stands out among a crowded migraine treatment landscape. 

Stephanie J. Nahas, MD

Articles

Determining Migraine Treatment Eligibility: Stephanie J. Nahas, MD

Underutilization of Preventive Migraine Treatments: Stephanie J. Nahas, MD

Optimizing Treatment in Acute Migraine: Stephanie J. Nahas, MD

Advantages of Fremanezumab Among CGRP Migraine Agents: Stephanie J. Nahas, MD