Korean headache society pushes for CGRP as 1st-line migraine treatment

As many headache societies worldwide recommend CGRP (calcitonin gene-related peptide) targeted therapies as first-line treatment for migraine, the Korean Headache Society (KHS) is also pushing for guideline revisions to reflect the global trend.

The KHS held its 2024 Fall Meeting and Korea-Japan Headache Symposium at the Dragon City Hotel in Yongsan-gu, Seoul, and held a news conference to announce the society's significant achievements and plans.

“This year, major international societies, including the American Headache Society, have revised their guidelines to recommend CGRP-targeted therapies as first-line treatments,” said Dr. Chu Min-kyung, a professor of neurology at Yonsei Severance Hospital who serves as the KHS president. “It is a big change to recommend the use of CGRP therapies even for patients with comorbidities or chronic diseases.”

Professor Kim Byung-su of the Department of Neurology at Ewha Womans University Mokdong Hospital and an academic director of KHS said, “We are finishing the revision of the cluster headache guideline and plan to share the results at an editorial board symposium next February and publish the PDF. After that, we will revise the migraine guidelines.”

The meeting also raised the need for reimbursement of new drugs for migraine treatment in Korea and for improvement of reimbursement criteria.

After using CGRP inhibitors for one year, patients must wait six months before they can be prescribed again. Still, studies have reported relapses within three months, making it necessary to relax the criteria, the KHS explained.

“Lasmiditan (Reyvow of Ildong Pharmaceutical) for migraine patients with cardiovascular disease has not yet been reimbursed,” Professor Chu said. “As it is also effective for patients without cardiovascular disease, it should be reimbursed to provide stronger treatment options.”

The issue of limited treatment options for cluster headaches in Korea was also raised. While Emgaliti of Lilly Korea (galcanezumab) is approved in a 300-mg dose for cluster headaches, only the 120-mg formulation is available in Korea.

“Although studies are showing the effectiveness of the 240-mg dose, the health authorities are willing to remove the cluster headache indication if there is no 300-mg formulation,” Professor Chu pointed out. “However, the company is also unwilling to introduce the 300mg formulation into Korea for economic reasons,” said Dr. Joo, explaining the current situation.

He continued, “If this continues, Korean cluster headache patients may lose out on a new treatment opportunity. We hope that the pharmaceutical company will introduce the formulation in Korea, and the government must also appropriately apply the system for patients.”

Regarding the government's pilot project to reorganize tertiary general hospitals to focus on severe diseases, Professor Son Jong-hee (KHS’ public relations director) of the Department of Neurology at Hallym University Chuncheon Sacred Heart Hospital said, “Efficient patient management systems should be established by, for instance, referring patients with intractable headaches or severe headaches to tertiary general hospitals.”

KHS plans to continue its public lectures to raise awareness of headaches, including cluster headaches. It will start with a lecture on pediatric headaches on Jan. 23, 2025. It will also hold spring and fall congresses in April and October next year.