EAN 2026 | Redefining success in preventive migraine care: what is ‘good enough’?

Migraine is a benign phenomenon, but it’s highly disabling. And until 2018, with the standard care, we were used to treat the patients for quite a short period of time, looking at most at a 50% response rate. That means a reduction by at least 50% of migraine frequency compared to baseline. This is also a good endpoint for the present studies, but we want more. And mostly patients want more. And we consider that probably the 75% response rate should be the new gold standard for migraine prevention. Because after all, migraine is a disorder that may progress in a proportion of patients, sometimes giving rise to the chronic form. And so we should, let’s say, reverse or tone down the dimension of the phenomenon reverting high-frequency episodic migraine or chronic migraine to a low-frequency episodic migraine. The hope is to provide no migraine. But to me, this is still a myth, and so it’s very difficult to reach. So we have to raise the bar, and we have to ask the drug to reduce much more the frequency of the disorder. And so we have to use all the tools we have with the drugs, with the right doses, with the right treatment period. And we also have to carefully establish a good relation with the patient to empower him, but also to check and to resolve concomitant disorders, sometimes very trivial, for example, head trauma or let’s say blood pressure increase, which may obviously happen after the fourth decade in roughly 30% of the patients, but also trying to improve the quality of life. So good enough, we should actually raise the bar and obtain an optimal response, which needs the good drug, the good therapeutic strategy, but a thorough evaluation of the patient trying to tailor a good treatment which is made of medicines but also of lifestyle. But every measure should be, let’s say, chosen together with the patient trying not to transform her or his life into an avoidant behavior. For example, hydration is a very simple method to improve the quality of life and to reduce migraine frequency in the patient, suggesting to respect the hours of sleep during the night is also quite a simple measure of improving the quality of life of the patient. We do not think that recommending not to eat some foods is a good way of treatment because the patient may well become phobic. On the other hand, we should teach the patient to avoid fasting.

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