Balancing Risks & Benefits of Migraine Treatments

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Key Questions
  • What are the potential risks and benefits associated with migraine treatments?
  • What treatment options exist for managing migraine disease?
  • To what degree do nonpharmacological approaches, such as lifestyle changes, contribute to migraine treatment?
  • Is the use of triptans safe for individuals aged 65 and older?
  • Who should not use triptans?
  • Do all migraine medications carry an equal likelihood of causing side effects?
  • Is there a genetic component to migraine disease?
  • What safety data is available for CGRP-targeted medications?
  • What is known about the long-term use of older medications?
  • How can we achieve the optimal balance between the benefits and side effects of migraine medications?
Interview Notes
Treatments Mentioned
  • Aerobic exercise
  • Amitriptyline
  • Biobehavioral treatments
  • CGRP monoclonal antibodies (mAbs)
  • CGRP small-molecule receptor antagonists (gepants)
  • Ditans (5HT1F receptor agonists)
  • Gabapentin
  • Lifestyle modifications
  • Neuromodulation devices
  • OnabotulinumtoxinA (Botox)
  • Propranolol
  • SEEDS (Sleep, Exercise, Eating, Diet, & Stress Management)
  • Topiramate (Topamax)
  • Triptans
  • Venlafaxine (Effexor XR)
  • Zavegepant (Zavzpret)

Please note: The Migraine World Summit’s aim is to bring you a variety of perspectives and expertise, independent of bias or judgment. Alternative theories presented in this video have not been medically reviewed. Views expressed in this interview do not necessarily represent the views of the Migraine World Summit. Please always consult your health care professional and do your own research before making changes to your treatment plan.

Amaal J. Starling, MD, FAHS, FAAN

Mayo Clinic, Arizona

Dr. Amaal J. Starling is an associate professor of neurology at the Mayo Clinic College of Medicine. She joined the Mayo Clinic in 2012 and is currently a consultant within the Department of Neurology. Dr. Starling received her medical degree from the Drexel University College of Medicine in Philadelphia. She completed a transitional year residency, a neurology residency, and a headache fellowship at the Mayo Clinic College of Medicine in Scottsdale, Ariz.

Dr. Starling is an active member of numerous migraine advocacy organizations, including the American Headache Society (AHS), the American Migraine Foundation, and the American Academy of Neurology (AAN). She is also involved in events supporting migraine, including Headache on the Hill, Miles for Migraine, and the Alliance for Headache Disorders Advocacy. Dr. Starling is currently serving on the AHS Board of Directors and is the chair of the AHS Advocacy Committee and a member of the AHS Diversity, Equity, and Inclusion Taskforce. Dr. Starling has been the recipient of numerous awards, including the AHS Above and Beyond Award for Service, Manfred D. Muenter Award for Excellence in Clinical Neurology, the AAN Annual Meeting Residency Scholarship, the 2012 Spirit of Mayo Clinic Award, and the Mayo Brothers Distinguished Fellowship Award.

Dr. Starling has authored numerous peer-reviewed publications and abstracts related to her fields of interest, which include migraine, concussion, post-traumatic headache, neuromodulation, and telemedicine. Dr. Starling’s hope is that her research and advocacy will advance care for people with migraine, post-traumatic headache, and other headache disorders. She envisions a future in which all people with headache disorders receive personalized, effective, and well-tolerated treatment options to improve their quality of life.

Interviews from Amaal J. Starling, MD, FAHS, FAAN

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Miles for Migraine is a registered 501(c)(3) nonprofit organization with the mission of improving the lives of people with migraine and other headache disorders, and their families, by raising public awareness about this disease, and helping to find a cure. Miles for Migraine produces fun walk/run events, typically a 2-mile walk and 5K and 10K races to raise money for migraine research. We also host adult education days, and a youth program for kids and teens impacted by migraine and other headache disorders.

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