Delphi consensus on the real-world application of the updated diagnostic and treatment guidelines for migraine in Asia Pacific

Abstract

Background Although diagnostic criteria and treatment guidelines for migraine are well-established, care remains suboptimal due to frequent misdiagnosis and undertreatment. This Delphi consensus aimed to explore how clinicians in the Asia-Pacific region approach migraine diagnosis and management.Methods This study used a modified-Delphi method, involving two rounds of surveys and a virtual scientific meeting with 14 headache-specialists from seven countries in Asia-Pacific. Consensus on statements was measured using a Likert scale ranging from 1 to 9, with consensus threshold set at 75%.Results The study had 100% participation in both surveys, and the scientific meeting was attended by 64.3% of participants. Out of 21 closed-ended statements, 12 reached consensus. Notably, 93% of participants reported using only ICHD-3 for migraine diagnosis, and 79% found the criteria easy to apply. For the diagnosis of migraine, all participants evaluated migraine-related disability and depression; 93% anxiety, and 86% sleep disturbances. Neck pain and dizziness were recognised as migraine-associated symptoms by 93% of respondents, with 85% reporting that 25-75% of their patients experience neck pain. Anti-CGRP mAbs were considered effective and addressed unmet needs for chronic or episodic migraine by 86% of participants. Efficacy (100%) was the primary deciding factor in selecting a specific anti-CGRP mAb, followed by safety (93%) and tolerability (86%). Factors such as frequency of administration (43%), perceived wearing-off effect (43%), availability and reimbursement (57%), and cost (58%) were less influential in decision-making. While 79% of the participants would consider anti-CGRP mAbs as first-line treatment, 93% believed these therapies would improve safety, adherence, and compliance outcomes. Only 7% of the participants favoured the use of gepants. Participants unanimously supported the use of anti-CGRP mAbs in adolescents (13-17 years), but not in children (6-12 years).Conclusion Consensus was reached on key aspects of migraine diagnosis and management. Participants endorsed the ICHD-3 criteria as the diagnostic standard and favoured using headache diaries, followed by MIDAS and HIT-6 for assessment. Anti-CGRP mAbs were recognised as effective in addressing unmet needs in migraine prevention. The panel advised against using anti-CGRP mAbs in children under 12 due to insufficient evidence, highlighting the need for more paediatric data.