The Paradigm Shift in Headache Management

By Alan M. Rapoport, M.D.

There has never been a more exciting time in the world of headache medicine. The FDA recently approved 3 CGRP (calcitonin gene-related peptide) blocking antibodies, exclusively for the prevention of migraine. Several small molecule CGRP receptor antagonists are in clinical trials. Multiple neuromodulation devices, one magnetic stimulator and some non-invasive devices working in conjunction with medications are being studied for migraine and cluster headache.

At the same time these groundbreaking therapies are being anticipated, there is a huge cultural shift in medicine toward patient-centered treatment plans, recognizing that there is no one-sizefitsall protocol. Every headache patient is different and needs individualized treatment for their own symptoms, triggers, and forms of disability.

A major problem is that even if the diagnosis and treatment of migraine is correct, not taking care of a medical, psychological, or social comorbidity prevents optimal outcomes.

New therapies, diagnostic and predictive apps, and electronic calendars can be utilized together for optimal outcomes. Individual patientderived data has allowed patients to partner with their doctors and share decisionmaking planning, leading to superior outcomes.

As you read the journeys of those living with migraine and headache diseases contained herein, you will note that many have failed multiple medications and other therapies. We are extremely optimistic that patients are about to feel like they are now partnering with their caregivers for optimal outcomes.

Alan M. Rapoport, MD, is a Professor of Neurology at the David Geffen School of Medicine at UCLA in Los Angeles, Past-President of the International Headache Society, Founder and Director-Emeritus of The New England Center for Headache in Stamford, Connecticut, and co-founder and CEO of, an electronic headache history and tracking system.