When One Treatment Isn’t Enough: Layering Therapies in Migraine Management
Key Questions
- What are the differences between chronic, episodic, and high-frequency episodic migraine?
- Can chronic migraine change to episodic migraine with effective preventive treatment over time?
- What is the difference between acute and preventive treatment?
- Can treatments used for episodic migraine also be used for chronic migraine? Which treatments work well for both types of migraine?
- What is treatment layering? How does it work?
- When might a healthcare provider choose to layer medications to treat migraine?
- What are possible side effects from layering treatments?
- What options exist for patients if both acute and preventive treatments fail?
- When might a patient stop using a preventive treatment?
- What is multimodal treatment, and how does it differ from layering treatment?
- What are the current first-line treatment options for migraine?
Interview Notes
- Article: “Calcitonin gene-related peptide-targeting therapies are a first-line option for the prevention of migraine: An American Headache Society position statement update”
- X: @mrobbinsmd
- LinkedIn: Matthew Robbins, MD, FAAN, FAHS
Treatments Mentioned
- Acetaminophen/Paracetamol (Tylenol/Panadol)
- Atogepant (Aquipta/Qulipta)
- Beta-blockers
- Biofeedback
- Cognitive behavioral therapy (CBT)
- CGRP small-molecule receptor antagonists (gepants)
- Ditans
- Metoclopramide
- Nerve blocks
- Neuromodulation devices
- NSAIDs
- Propranolol
- Sumatriptan and naproxen sodium (Treximet)
- Sphenopalatine ganglion (SPG) block
- Triptans
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.
Matthew Robbins, MD
Associate Professor of Neurology & Residency Program Director
Weill Cornell Medicine, NewYork-Presbyterian Hospital
Dr. Robbins earned his bachelor’s degree from Yale University and his MD from SUNY-Downstate College of Medicine. He completed his neurology residency, chief residency, and headache fellowship at the Albert Einstein College of Medicine/Montefiore. He served on the faculty at Montefiore-Einstein for nearly a decade in roles including chief of neurology at the Jack D. Weiler Hospital and director of inpatient services for the Montefiore Headache Center. He joined Weill Cornell in 2018, where he is the neurology residency program director, the Louis and Rachel Rudin Foundation Education Scholar, and an associate professor of neurology.
Dr. Robbins is the president-elect of the American Headache Society (AHS) and co-directs the AHS Resident Education Program. He is the president-elect of the New York State Neurological Society. He has served on the editorial boards of multiple neurology journals, including Continuum and Headache, and has won teaching awards from the American Academy of Neurology, AHS, National Headache Foundation, Albert Einstein College of Medicine, and Weill Cornell.
He has led organizational initiatives related to headache, including guidelines, consensus statements, and quality measures. He is active in advocacy activities, including the Palatucci Advocacy Leadership Forum, serving multiple times as an adviser and faculty member.
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The Global Healthy Living Foundation is a 501(c)(3) nonprofit organization whose mission is to improve the quality of life for people with chronic illnesses (such as arthritis, osteoporosis, migraine, psoriasis, asthma, alopecia, inflammatory bowel disease, and cardiovascular disease) by advocating for improved access to health care at the community, state, and federal levels, and amplifying education and awareness efforts within its social media framework.
At AbbVie, we are committed to empowering people living with migraine disease. We advance science that enables health care providers to care for people impacted across the spectrum of migraine. Through education and partnerships with the migraine community, we strive to help those with migraine navigate barriers to care, access effective treatments and reduce the impact of migraine on their lives. To learn more, visit AbbVie.com.
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