Assessing When to Take a Nonoral Approach to Migraine: Jessica Ailani, MD


The director of the MedStar Georgetown Headache Center spoke to the considerations she makes in determining when patients with migraine may need a nonoral therapy to address their disease.

“When I’m thinking about a patient who has maybe failed an oral triptan, who has failed their standard of care, this is when I might think about DHE. Somebody who has a longer attack or someone who is known to delay treatment.”

The success of intranasal dihydroergotamine (DHE) administered via a novel precision olfactory delivery (POD) system, known as INP104, in the STOP 301 trial (NCT03557333) has been an example of an effective nonoral approach to migraine care. As many of the migraine therapies available are currently either infusion or oral treatments, the introduction of intranasal administration has opened a window for more variety for patients.

Intranasal delivery is particularly promising in the case of patients who experience nausea from their migraines—one of the more common most bothersome symptoms reported by patients. In these instances, according to migraine specialist Jessica Ailani, nasal therapies are an excellent option to offer individuals. Additionally, some of these nonoral therapies have a more rapid onset of action, allowing for a quicker response to treatment. When it comes to DHE, a therapy that does not offer an oral formulation, she noted, this intranasal route is particularly helpful for patients who are known to delay their treatment due to long-lasting attacks.

At the 2021 American Academy of Neurology (AAN) Annual Meeting, April 17-22, Ailani gave a talk in an industry update session that covered some of the ongoing conversations about the use of nonoral medications for migraine. Ailani, the director of the MedStar Georgetown Headache Center and associate professor of neurology at MedStar Georgetown University Hospital, shared with NeurologyLive her takeaways from the STOP 301 data, as well as when she thinks about taking nonoral approaches for her patients and what advantages that they can offer due to the ongoing interactions between gut health and the brain.

For more coverage of AAN 2021, click here.

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