Migraine-advanced preventative treatments: the British Association for the Study of Headache Clinical Practice Recommendations and Consensus Guidance

This is a consensus guidance document developed by the British Association for the Study of Headache (BASH), of practical recommendations in the use of advanced migraine treatments based on the current literature, guidelines, real-world experience and opinion from an expert consensus group. The target audience for this statement includes all clinical and allied healthcare professionals interested in headache. The introduction of calcitonin gene-related peptide-targeted migraine treatments in addition to botulinum toxin has widened the choice of migraine treatment options. However, there is a lack of consistency in the use and treatment of accessibility across the UK. We have developed a multidisciplinary consensus clinical guidance that makes recommendations on how to use advanced preventative treatments for migraine. The BASH consensus group was composed of consultants, nurses and general practitioners with specialist's experience in headache. Key clinical questions were agreed by consensus. Each recommendation was based on a selective search of evidence, including meta-analyses, systematic reviews and considered relevant national standards of care. A modified Delphi process was used to obtain consensus on the recommendations via an anonymous voting process by the Consensus Group and BASH Council members. Those not reaching the minimum required consensus level (≥75%) were amended until agreement was reached or were designated as lacking consensus. Expert practical recommendations on advanced migraine treatments covering common dilemmas are presented. These recommendations aim to optimise patient access and experience of advanced migraine treatments. This document will need to be revised periodically as new evidence emerges.