Migraine management in Saudi Arabia: An expert consensus.

Objective: To establish expert consensus on the preventive treatment of migraine in Saudi Arabia, with a focus on the use of calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs), in light of the latest international guidelines and local clinical practice.

Method: A record-based study was performed retrospectively in Radiology department at our Hospital in Eastern region of Saudi Arabia, from Jan. 2019-2024. Adult patients for whom MRI brains were conducted for epilepsy work-up with added SWAN (susceptibility weighted angiography) sasequence were considered. Brain tumor, post-injury, and post-surgery cases were excluded. A venous angioma was documented when a tuft of veins drained to a larger vein (traversing through cortex or reaching under ependymal layer), appeared low signal curvilinear brnaching structure on SWAN image. The usefulness of the SWAN sequence in the detection of venous malformation determined if the visualized abnormality was found to be related to a focus resulting in abnormal waves on the brain electroencephalography. This observation was compared to the accidently found such malformations that were seen in epileptic patients with normal EEGs (control group). Fisher's Exact test was applied and a p-value of <0.05 was taken as statistically significant for an association.

Results: The expert panel reviewed updated clinical data and recent international guidelines recommending CGRP mAbs as first-line preventive treatment options. The panel reached consensus on key aspects of migraine management in Saudi Arabia, including treatment initiation criteria, patient selection, and the role of CGRP mAbs in clinical practice. The recommendations emphasize the need for earlier initiation of effective treatments to reduce disease burden and improve quality of life.

Conclusion: This expert consensus provides updated guidance on the preventive treatment of migraine in Saudi Arabia, supporting the integration of CGRP mAbs as a first-line option. These recommendations aim to enhance the standard of migraine care and address unmet needs in the local healthcare setting.