Expert consensus established around flexible, individualized migraine treatment utilizing a modified Delphi panel

Author:

Graf Marlon1ORCID,Kim Edward2,Brewer Iris1,Hernandez Jennifer1,Chou Jacquelyn W.1,Cirillo Jessica2,Jensen Christopher2,Lipton Richard3

Affiliation:

1. PRECISIONheor Bethesda Maryland USA

2. Biohaven Pharmaceuticals, Inc New Haven Connecticut USA

3. Albert Einstein College of Medicine Bronx New York USA

Abstract

AbstractObjectiveTo characterize treatment decision‐making processes and formalize consensus regarding key factors headache specialists consider in treatment decisions for patients with migraine, considering novel therapies.BackgroundMigraine therapies have long been subject to binary classification, acute versus preventive, due to limitations of available drugs. The emergence of novel therapies that can be used more flexibly creates an opportunity to rethink this binary classification. To determine the role of these novel therapies in treatment, it is critical to understand whether existing guidelines reflect clinical practice and to establish consensus around factors driving management.MethodsA three‐round modified Delphi process was conducted with migraine clinical experts. Round 1 consisted of an online questionnaire; Round 2 involved an online discussion of aggregated Round 1 results; and Round 3 allowed participants to revise Round 1 responses, incorporating Round 2 insights. Questions elicited likelihood ratings (0 = highly unlikely to 100 = highly likely), rankings, and estimates on treatment decision‐making.ResultsNineteen experts completed three Delphi rounds. Experts strongly agreed on definitions for “acute” (median = 100, inter‐quartile range [IQR] = 5) and “preventive” treatment (median = 90, IQR = 15), but noted a need for treatment customization for patients (median = 100, IQR = 6). Experts noted certain aspects of guidelines may no longer apply based on established tolerability and efficacy of newer acute and preventive agents (median = 91, IQR = 17). Further, experts agreed on a treatment category referred to as “situational prevention” (or “short‐term prevention”) for patients with reliable and predictable migraine triggers (median = 100, IQR = 10) or time‐limited periods when headache avoidance is important (median = 100, IQR = 12).ConclusionsUsing the modified Delphi method, a panel of migraine experts identified the importance of customizing treatment for people with migraine and the utility of “situational prevention,” given the ability of new treatment options to meet this need and the potential to clinically identify patients and time periods when this approach would add value.

Publisher

Wiley

Subject

Neurology (clinical),Neurology

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