Unmet Needs in Headache Management

  • Andrea NegroEmail author
  • Paolo Martelletti
Part of the Headache book series (HEAD)


Despite the progress in migraine management, many unmet needs remain. Some patients who would benefit from medical consultation for their headaches may not seek it and even if they do may not receive a diagnosis or an optimal therapy. Physician-patient communication and patients’ involvement and agreement on care and treatment plan are associated with improved patient adherence and compliance with prescribed medication, improved satisfaction, resolution of emotional and physical symptoms, and fewer repeated consultations. Patients have several expectations about the attributes of migraine medications such as effective and long-lasting pain relief, low rate of migraine recurrence, few side effects, easy route of administration, low number of doses needed to achieve pain relief, effective relief of associated symptoms, and fast return to normal activities. A minority of patients use migraine-specific agents, such as triptans or dihydroergotamine, and overall satisfaction with therapy is modest with low treatment persistence and high discontinuation rates. Triptan therapy can be optimized by changing timing, dose or route of administration, switching triptan, or adding treatments to the currently prescribed triptan. Also a significant proportion of chronic migraine patients has unmet need. Many patients needing prevention do not receive it, and even when it is prescribed, there is low adherence mainly due to relatively low and inconstant efficacy and to bothersome side effects. The frequent side effects and contraindications of available acute and preventive treatments, together with the frequent comorbidities associated with migraine, make the optimization of treatment even more challenging.


Migraine Chronic migraine Treatment Unmet needs 


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Clinical and Molecular Medicine, Regional Referral Headache CentreSapienza University of Rome, Sant’Andrea HospitalRomeItaly

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