What Research Should Be Prioritized for Chronic Migraine Prevention?
Patients and clinicians agreed that head-to-head trials comparing CGRP antibodies to Botox should be the top chronic migraine research priority.
Quick Facts
What This Study Found
Using nominal group technique (a structured consensus method), the stakeholders identified their research priorities:
1. Top priority: Comparing CGRP monoclonal antibodies to onabotulinumtoxinA (Botox)
2. High priority: Candesartan vs placebo
3. High priority: Flunarizine vs placebo
4. Also discussed: Combining CGRP antibodies with other medications
The group noted that despite multiple available chronic migraine preventives, high-quality head-to-head randomized evidence is scarce. Most drugs were tested only against placebo, making it hard for clinicians and patients to choose between options.
Key Numbers
- 8 chronic migraine patients participated
- 11 healthcare professionals participated
- Top priority: CGRP mAbs vs onabotulinumtoxinA
- Drug priorities vs placebo: candesartan and flunarizine
- Chronic migraine: headaches on ≥15 days per month
How They Did This
Online consensus workshop using nominal group technique, a structured approach where participants independently generate ideas, share them, discuss, and rank priorities through voting. Eight people with chronic migraine and eleven healthcare professionals participated.
Why This Research Matters
Chronic migraine affects about 2% of the global population. Multiple preventive treatments exist (Botox, CGRP antibodies, topiramate, amitriptyline, candesartan, flunarizine) but doctors have little evidence to guide which to try first. This patient-clinician consensus highlights the most urgent evidence gaps from the perspective of those most affected.
The Bigger Picture
Multiple preventive treatments exist for chronic migraine but doctors lack evidence on which to try first. Patient-clinician consensus on research priorities helps focus limited research resources on the most impactful questions.
What This Study Doesn't Tell Us
Small sample size (19 participants). UK-based, so priorities may differ in other healthcare systems. Nominal group technique produces consensus but may not represent the full range of patient and clinician perspectives. The workshop format limits deep exploration of any single topic. Funding for the identified trials is not guaranteed.
Questions This Raises
- ?Why haven't CGRP antibodies been compared head-to-head with Botox yet?
- ?Would research priorities differ in other countries?
Trust & Context
- Key Stat:
- CGRP vs Botox: #1 priority Both patients and clinicians agreed that comparing these two leading preventive treatments should be the top research focus
- Evidence Grade:
- Rated not applicable: this is a consensus workshop identifying research priorities, not a study measuring treatment effects.
- Study Age:
- Published in 2024. Reflects current clinical uncertainty about treatment sequencing for chronic migraine.
- Original Title:
- Research priorities for randomised controlled trials in chronic migraine preventive medication: A stakeholder consensus workshop.
- Published In:
- NIHR open research, 4, 16 (2024)
- Authors:
- Rees, Sophie, Cooklin, Andrew, Duncan, Callum, Matharu, Manjit, Naghdi, Seyran, Underwood, Martin, Mistry, Hema
- Database ID:
- RPEP-09133
Evidence Hierarchy
Frequently Asked Questions
Which is better for chronic migraine: CGRP drugs or Botox?
We don't know yet — no head-to-head trial has been done. Both patients and doctors identified this comparison as the most important research question.
Why is this question so important?
Insurance companies often require patients to try one before the other. Without head-to-head data, the order is arbitrary rather than evidence-based.
Read More on RethinkPeptides
Cite This Study
https://rethinkpeptides.com/research/RPEP-09133APA
Rees, Sophie; Cooklin, Andrew; Duncan, Callum; Matharu, Manjit; Naghdi, Seyran; Underwood, Martin; Mistry, Hema. (2024). Research priorities for randomised controlled trials in chronic migraine preventive medication: A stakeholder consensus workshop.. NIHR open research, 4, 16. https://doi.org/10.3310/nihropenres.13548.2
MLA
Rees, Sophie, et al. "Research priorities for randomised controlled trials in chronic migraine preventive medication: A stakeholder consensus workshop.." NIHR open research, 2024. https://doi.org/10.3310/nihropenres.13548.2
RethinkPeptides
RethinkPeptides Research Database. "Research priorities for randomised controlled trials in chro..." RPEP-09133. Retrieved from https://rethinkpeptides.com/research/rees-2024-research-priorities-for-randomised
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkPeptides research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.