{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T16:24:18Z","timestamp":1790267058062,"version":"4.1.0"},"reference-count":40,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,3,15]],"date-time":"2023-03-15T00:00:00Z","timestamp":1678838400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["headachejournal.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Headache"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To characterize treatment decision\u2010making processes and formalize consensus regarding key factors headache specialists consider in treatment decisions for patients with migraine, considering novel therapies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Migraine therapies have long been subject to binary classification, acute versus preventive, due to limitations of available drugs. The emergence of novel therapies that can be used more flexibly creates an opportunity to rethink this binary classification. To determine the role of these novel therapies in treatment, it is critical to understand whether existing guidelines reflect clinical practice and to establish consensus around factors driving management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A three\u2010round modified Delphi process was conducted with migraine clinical experts. Round 1 consisted of an online questionnaire; Round 2 involved an online discussion of aggregated Round 1 results; and Round 3 allowed participants to revise Round 1 responses, incorporating Round 2 insights. Questions elicited likelihood ratings (0\u00a0=\u2009highly unlikely to 100\u00a0=\u00a0highly likely), rankings, and estimates on treatment decision\u2010making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nineteen experts completed three Delphi rounds. Experts strongly agreed on definitions for \u201cacute\u201d (median\u00a0=\u2009100, inter\u2010quartile range [IQR]\u00a0=\u00a05) and \u201cpreventive\u201d treatment (median\u00a0=\u00a090, IQR\u00a0=\u00a015), but noted a need for treatment customization for patients (median\u00a0=\u00a0100, IQR\u00a0=\u00a06). Experts noted certain aspects of guidelines may no longer apply based on established tolerability and efficacy of newer acute and preventive agents (median\u00a0=\u00a091, IQR\u00a0=\u00a017). Further, experts agreed on a treatment category referred to as \u201csituational prevention\u201d (or \u201cshort\u2010term prevention\u201d) for patients with reliable and predictable migraine triggers (median\u00a0=\u00a0100, IQR\u00a0=\u00a010) or time\u2010limited periods when headache avoidance is important (median\u00a0=\u00a0100, IQR\u00a0=\u00a012).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Using the modified Delphi method, a panel of migraine experts identified the importance of customizing treatment for people with migraine and the utility of \u201csituational prevention,\u201d given the ability of new treatment options to meet this need and the potential to clinically identify patients and time periods when this approach would add value.<\/jats:p>\n                  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