British Association for Study of Headache Issues Consensus Guidance for Advanced Migraine Treatments

Migraine is a debilitating neurological condition, yet significant inconsistencies persist in the accessibility and application of advanced preventative treatments across the UK. Current standard-of-care options often fall short for patients with refractory migraine, necessitating a broader and more standardized approach. The emergence of calcitonin gene-related peptide (CGRP)-targeted therapies and established treatments like botulinum toxin has expanded the therapeutic landscape, but a lack of clear, unified clinical guidance hinders optimal patient management and equitable access to these effective options. This document aims to bridge that gap.

The British Association for the Study of Headache (BASH) convened a multidisciplinary expert consensus group comprising consultants, nurses, and general practitioners specializing in headache. Key clinical questions were established by consensus. Recommendations were formulated based on a selective review of existing evidence, including meta-analyses, systematic reviews, and relevant national standards. A modified Delphi process was employed for anonymous voting by the Consensus Group and BASH Council members. Recommendations required a minimum consensus level of ≥75%; those not meeting this threshold were revised until agreement or designated as lacking consensus.

The BASH consensus group successfully developed comprehensive, expert practical recommendations for advanced migraine treatments, specifically addressing common clinical dilemmas and aiming to optimize patient access and experience.

These recommendations integrate current literature, guidelines, and real-world expert opinion for calcitonin gene-related peptide (CGRP)-targeted therapies and botulinum toxin. The Delphi process ensured robust agreement, with all accepted recommendations achieving a ≥75% consensus level among the expert panel. The guidance directly addresses the previously noted lack of consistency in treatment use and accessibility across the UK, providing a unified framework for healthcare professionals. While specific treatment protocols are detailed within the full guidance, the abstract highlights the successful establishment of a standardized approach to advanced migraine prevention.