How do you decide on switching to a different preventative anti-CGRP treatment in migraine patients who are experiencing reduced effectiveness with their current treatment?
The CGRP antibodies and gepants are my preventive treatments of choice. In fact, I hardly ever prescribe anything else anymore preventively, including botulinum toxin. Tolerability issues I hardly ever encounter with the antibodies, but sometimes I do with the gepants, in particular fat...
On occasion, I have found that patients who were diagnosed with chronic migraine actually have EPH or CPH and respond to an indomethacin trial. Alternatively, those with less-than-ideal responses to CGRP antagonists or gepants, Botox injections can offer more relief. These patients tend to have a si...
If we have not achieved a desired efficacy, such as >50% improvement in headache frequency and/or frequency of severe headaches, or a patient perceives that a migraine disorder still significantly impacts the quality of life, I switch between different anti-CGRP treatments. I try at lea...