[Modern migraine therapy-interdisciplinary long-term care].

Area of Science:

• Neurology
• Internal Medicine

Background:

• Migraine is a prevalent neurological disorder with a significant burden, necessitating long-term management.
• Current treatment paradigms require extensive, often lifelong, patient monitoring and care.
• Specialist neurological expertise is crucial for accurate diagnosis and managing complex therapeutic challenges.

Purpose of the Study:

• To delineate the roles of general practitioners, internists, and neurologists in migraine management.
• To outline appropriate treatment pathways for acute and prophylactic migraine therapies.
• To emphasize the necessity of specialist involvement for advanced treatments.

Main Methods:

• Diagnosis relies on International Headache Society (ICHD-3) criteria.
• Assessment involves evaluating clinical phenotype and neurological symptoms.
• Treatment escalation is guided by therapeutic response and complexity.

Main Results:

• General practitioners and internists can manage acute therapies (antiemetics, analgesics, triptans) and initial prophylactic treatments (supplements, certain medications) if used sparingly.
• Specialized neurological input is required when initial therapies fail or for advanced treatments.
• Neurologists and pain therapists are key for managing complex cases and prescribing specialized therapies such as Onabotulinumtoxin A and monoclonal CGRP antibodies.

Conclusions:

• Effective migraine management is a collaborative effort, leveraging primary care for routine aspects and neurology for complex care.
• Clear guidelines for treatment escalation ensure optimal patient outcomes.
• The evolving landscape of migraine therapeutics necessitates ongoing collaboration between primary and specialist care providers.