• Theresa Mallick-Searle and Maureen Moriarty.
• Stanford Health Care, Division of Pain Medicine, Redwood City, California.
• J Am Assoc Nurse Pract. 2020 Apr 16; 33 (6): 419-428.

BackgroundMigraine is a prevalent and chronic disease associated with high rates of disability and significant financial and socioeconomic burden. Current acute treatments for migraine attacks include both migraine-specific (e.g., triptans, ergotamines) and nonspecific (e.g., nonsteroidal anti-inflammatory drugs) medications; however, significant unmet treatment needs remain.ObjectivesThe authors sought to characterize the nature and drivers of unmet treatment needs in the acute treatment of migraine attacks and describe emerging migraine-specific treatments, that is, calcitonin gene-related peptide (CGRP) receptor antagonists.Data SourcesPubMed searches were conducted using search terms for studies of unmet migraine treatment needs and CGRP receptor antagonists. Additionally, studies presented at recent headache-focused congresses were included.ConclusionsForty percent of people with migraine report at least 1 unmet treatment need. Many people are unable to use migraine-specific or nonspecific agents because of contraindications, precautions, and tolerability issues. Disease burden (disability, headache severity/frequency) remains high even in those receiving migraine-specific medications. The oral CGRP receptor antagonists, ubrogepant and rimegepant, demonstrated efficacy in reducing migraine pain, migraine-associated symptoms, and disability, with a low adverse event profile, similar to placebo.Implications For PracticeThe availability and use of CGRP receptor antagonists may help reduce the extent of unmet needs in the treatment of migraine attacks, resulting in more patients receiving treatment and better outcomes for people with migraine. Nurse practitioners are well positioned to increase rates of migraine diagnosis/treatment (another key unmet need), using consensus guidelines to guide their approach.Copyright © 2020 The Authors. Published by Wolters Kluwer on behalf of the American Association of Nurse Practitioners.

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