The importance of an early onset of migraine prevention: an evidence-based, hypothesis-driven scoping literature review.

Recently approved migraine preventive therapies facilitate rapid control of migraine activity, potentially improving patients' lives and minimizing the societal burden of migraine. This review synthesizes available evidence on rates and timing of early onset of migraine prevention and identifies patient-level outcomes related to early onset prevention. This evidence-based scoping review identified all available clinical trial evidence regarding the early onset of prevention of migraine, under the hypothesis 'Patients with migraine (episodic or chronic) report additional benefits when receiving an approved migraine preventive treatment that demonstrates an early onset of prevention '. Early onset of prevention was defined as migraine preventive benefits within 30 days post-administration. PubMed, EMBASE, and CINAHL were searched for publications between 1988 and 2020. Overall, 16 publications described 18 studies. All studies were conducted in approved treatments [four anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies and one chemodenervation agent] in patients with episodic/chronic migraine; no publications were identified for traditional oral agents for early migraine prevention. Compared to placebo, erenumab (three studies) reduced weekly migraine days within 1 week; fremanezumab (six studies) increased reports of no headache of at least moderate severity on Day 1 and significantly reduced migraine frequency within 1 week; galcanezumab (three studies) significantly reduced the mean number of patients with migraine beginning Day 1 and each day of the first week; eptinezumab (four studies) significantly reduced migraine attack likelihood on Day 1 by > 50% versus baseline; and onabotulinumtoxinA (two studies) reduced headache and migraine days within 1 week. Four publications described function, disability, and quality of life improvements as early as Week 4; none reported cost-benefit. Anti-CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab, and eptinezumab) and a chemodenervation agent (onabotulinumtoxinA) provide clinically relevant benefits during the first treatment week. Literature describing clinically relevant benefits regarding early onset of prevention in patients with migraine is limited.
Competing Interests: Declaration of Conflicting Interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: C.G. has been a paid consultant for Alder/Lundbeck, Biohaven, Amgen/Novartis, Theranica, Axsome, Upsher Smith, Spherix Global Insights, and Vorso and has been a past member of speaker bureaus for Amgen/Novartis, Allergan/AbbVie, Biohaven, Lilly, Theranica, and Upsher Smith. He served as an Associate Editor of Headache until 2020 and is a board member of the Headache Cooperative of New England (HCNE). D.C.B. has received grant support from the Food and Drug Administration and the National Headache Foundation and grant support and honoraria from Allergan, Amgen, Lilly, Lundbeck, and Teva. She serves on the editorial board of Current Pain and Headache Reports. M.J.M. has received compensation for consultation from Lundbeck and Theranica. He has participated in speaker bureaus for Lilly and Amgen/Novartis. He has received salary support for serving as principal investigator from Teva, GammaCore, and Allergan/AbbVie. He has received payments for authorship or royalties from Demos Medical, Cambridge University Press, and MedLink. B.T. has received compensation for consulting from Amgen, Novartis, Biohaven, Lilly, Lundbeck, Teva, and Theranica. He has participated in speaker bureaus with Allergan/AbbVie, Amgen, Biohaven, Lilly, Lundbeck, and Teva, and he has received financial compensation for serving as principal investigator with Amgen and Theranica. J.M.P. has received grant support from the National Institutes of Health and compensation for consulting from Alder/Lundbeck, Allergan/AbbVie, Amgen/Novartis, and Biohaven. P.K.D. has received grant support from Amgen/Novartis, Allergan/AbbVie, and Lilly. She serves as Editor in Chief of Migraine Again, Editor at Large of Everyday Health, and Co-Producer/Co-Owner of Migraine World Summit, which is supported by Lundbeck, Impel, Lilly, Allergan/AbbVie, Axon Optics, and Teva. N.L. has no compensation or conflicts to report. All funding or sponsorships are directed to the American Migraine Foundation. A.B. serves as a consultant and/or a promotional speaker for Alder, Allergan, Amgen, Biohaven, electroCore, Lilly, Lundbeck, Novartis, Promius, Supernus, Teva, and Theranica.
(© The Author(s), 2022.)