Considerations for management of migraine symptoms in the primary care setting

ABSTRACT

Migraine is a common disabling brain disorder that affects one in seven US citizens annually. The burden of migraine is substantial, both in economic terms and for individual patients and their close family members. Initial medical consultations for migraine are usually with a primary care physician (PCP), and it is predominantly managed in a primary care setting; therefore, PCPs need a thorough understanding of migraine and the treatment options. This review provides an overview of the prevalence, symptoms, burden, and diagnosis of migraine with a focus on adults. Important aspects of migraine management, such as medication overuse and chronic migraine, are highlighted and insight is provided into factors for consideration when prescribing acute/abortive treatment for migraine to ensure that individual patients receive optimal pharmaceutical management. The effects of associated symptoms, e.g. nausea/vomiting, on treatment efficacy are pertinent in migraine; however, many therapy options, including alternative delivery systems, are available, thus facilitating the selection of optimal treatment for an individual patient.

KEYWORDS:

• Migraine
• symptoms
• burden
• primary care physicians
• individualized treatment
• non-oral therapy

Financial and competing interests disclosure

Editorial assistance was provided by Katherine Oldfield of Anthemis Consulting Ltd, funded by Teva Pharmaceutical Industries (Frazer, PA, USA). Teva provided a single medical accuracy review of the final draft. The author was not compensated and retained full editorial control over the content of the paper. S Silberstein receives honoraria, as a consultant and/or advisory panel member, from Alder Biopharmaceuticals, Allergan, Inc., Amgen, Avanir Pharmaceuticals, Inc., Curelator, Inc., Depomed, Dr. Reddy’s Laboratories, eNeura Inc., electroCore Medical, LLC, Lilly USA, LLC, Supernus Pharmaceuticals, Inc., Teva Pharmaceuticals, and Trigemina, Inc. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.