Forgot Password?
Return to Course Listing

CME: Migraine Headaches: Therapeutic Updates and Contemporary Management Strategies


Activity Description / Statement of Need:

In this online, self-learning activity:

Migraine headache is the leading condition of recurrent cephalalgias of moderate or severe intensity. The condition has been identified as one of the most common neurological disorders occurring in adult women (17%) approximately three times more than in men: in the U.S. 17.1% of women and 5.6% of men experience at least one migraine per year. It is one of the top five reasons for emergency department visits by patients ages 18 to 44.

A provider’s first priority when seeing a patient with headaches is to determine whether the patient is presenting with a primary headache disorder or a secondary headache disorder. Primary headache disorders include migraine headaches, tension-type headaches, and cluster headaches. Secondary headaches are those attributed to an underlying condition such as infection, trauma, vascular disorders, or structural lesions. They cost thousands of per patient per year and are the third leading cause of disability in the world.


Recent Advances in Therapeutics Now Informing

Mechanism of Disease

Recent Advances in Therapeutics Now Informing

Mechanism of Disease

Target Audience:

Healthcare professionals who are: primary care physicians, neurologists, headache specialists, nurse practitioners, physician assistants, nurses, and pharmacists who specialize in neurology and primary care; and those who otherwise commonly care for or clinically encounter patients who may experience migraine headache.

This program is supported by an educational grant from AMGEN.

This activity is free of charge.

Release Date: May 31, 2019 -- Expiration Date: May 31, 2021

Faculty: Joshua Kamins, MD



Primer and updates on the epidemiology, pathophysiology, clinical presentation, and diagnosis of migraine headaches

  • Statistics and burden: Global Burden of Disease study, MIGRAINE: Incidence and Impact
  • Pathophysiology
  • Vascular Theory of Migraine: Aura phase & headache phase
  • Changing concepts of migraine: anatomy, pathophysiology, timeline, imaging studies
  • Diagnosis of episodic and chronic migraines and subtypes
  • Criteria: ICHD
  • Comorbidities
  • Symptomology, misdiagnosis, and triggers
  • Patient case(s)

Updates in the treatment of patients with migraine headaches

  • Approach to the headache patient: patient reassurance, identification of changing and exacerbating external factors and concomitant medications, choice of rescue therapy, determination of whether preventive therapy is appropriate
  • Role of neuroimaging
  • Review of present therapies and emerging pharmacotherapy and their respective, anticipated roles
  • Chronic migraine
    • Prophylaxis
      • Calcitonin gene-related peptide (CGRP) inhibitors
        • Physiology of biological therapies’ roles in migraine treatment
        • OnabotulinumtoxinA
        • Conventional therapies: antiepileptic drugs (e.g., topiramate), antihypertensives, antidepressants
        • Investigational
          • Pituitary adenylate cyclase-activating polypeptide type 1 (PAC1) receptor inhibitors
          • Treatment resistant migraine: repository corticotropin injection
          • Occipital nerve block
    • Novel serotonergic agents Acute
      • Triptans (newer and investigation therapies include novel routes of administration; e.g., inhalation)
      • Novel serotonergic agents
      • NSAIDS and antiemetics
      • Acute: inhaled oxygen, intranasal lidocaine; preventive: short-course steroid therapy, memantine, melatonin, lithium
      • Treating comorbidities
      • Addressing the socioeconomic burden of migraine
      • Collaborative, team-based approach between disciplines
  • Different treatment approaches in cluster headaches
  • Role of neurostimulation
  • Treatment pearls
  • Clinical quandaries: resistant cases
  • Minimizing barriers to care
  • Best practice: putting it all together
  • Patient case(s)

Learning Objectives

By the end of the session the participant will be able to:

  • Describe clinical features of migraines, the rationale for understanding migraine as a syndrome, and migraine neurochemistry (including calcitonin gene-related peptide, serotonin, etc.) such that that they inform pairing with treatment mechanisms
  • Describe the characteristics of diagnosis of episodic and chronic migraines and the qualities embodied by patients suitable for prophylactic pharmacotherapy, and apply that knowledge to patient cases
  • List present and emerging pharmacotherapeutic treatment options for both prophylactic and rescue therapies for migraine headaches and apply them to patient cases using evidence-based medicine
  • Describe challenges to the successful management of migraine, including through a collaborative care, team-based approach between disciplines



Faculty Disclosure and Resolution of COI

As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved thru content review ScientiaCME.


Faculty Disclosure:

Joshua Kamins, MD, professor at UCLA, has no relevant financial disclosures.

Disclosures of Educational Planners: Charles Turck, PharmD, BCPS, BCCCP has no relevant financial disclosures.

Commercial Support Disclosure: This program is supported by an educational grant from AMGEN.


  • Read the learning objectives above
  • Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowledge gained by participating in this CME activity.
  • View the online activity. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.
  • Minimum participation threshold: Take the post-test. A score of 70% or higher is required to pass and proceed to the activity evaluation.
  • Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.

Cultural/Linguistic Competence & Health Disparities

System Requirements

Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
Mac OS 10.2.8
Safari or Chrome or Firefox
*Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh

*Required to view Printable PDF Version

Perform Pre-Test (optional)

Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.

Additional Courses That Are Related To This Activity

Parkinson's disease: Optimizing pharmacotherapeutic management strategies and addressing clinical challenges

Chronic inflammatory demyelinating polyneuropathy (CIDP): Optimizing pharmacotherapeutic management strategies

Alzheimer Disease and Its Complications: Best Practices, Emerging Therapies, and Barriers to Care

Transthyretin amyloidosis (ATTR) and its complications: Optimizing management strategies