Advancements and Updates to the Treatment Algorithm of Migraine: Emad Estemalik, MD


The director of the headache section at Cleveland Clinic’s Neurological Institute gave an administrative perspective on the changes to how patients with migraine are cared for, led by significant developments in recent years. [WATCH TIME: 4 minutes]

WATCH TIME: 4 minutes

"The other element, which we put emphasis on, is that imaging is becoming far more sophisticated. We talk about the 1.5 Tesla MRIs, the 3T MRIs, they keep updating. These additional incredible imaging tools are giving us more information when it comes to secondary headaches."

Several in neurology believe there is no better time to be a neurologist, considering how quickly the science is evolving and how its changed from a once diagnostic specialty to a therapeutic one. Migraine, the most common neurologic condition, is characterized by unilateral, throbbing/pounding headache accompanied by photophobia, phonophobia, nausea, vomiting, and disability. Despite the detrimental effects migraine can have on quality of life, progress across drug development has given patients with a wide range of options, pharmacological and nonpharmacological, to choose from.

More recently, the introduction of calcitonin gene-related peptide (CGRP)-targeting therapies has altered the way patients are treated, as these agents have proven to be among the most effective and safe. Emad Estemalik, MD, director of the headache section at Cleveland Clinic’s Neurological Institute, believes the field has had a “complete modification of the treatment algorithm” for patients with migraine, noting the impact that CGRPs have made. Prior to the 2023 Scottsdale Headache Symposium, held by the American Headache Society, Estemalik sat down with NeurologyLive® to give an in-depth overview of the changes in how migraine is treated from an administrative perspective.

Estemalik, who also serves as the chair for International Business Development at Cleveland Clinic’s International Operations and assistant professor of neurology at the Lerner School of Medicine, provided commentary on how a culmination of CGRPs, neuromodulation techniques, and nonpharmacological approaches, have changed the field. Additionally, he spoke on the role of advanced imaging, and what that provides in the diagnosis and treatment for secondary headaches.

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