Rattanawong, Wanakorn

Preferred name

Alternative Name

Rattanawong, W.

Main Affiliation

Faculty of Medicine

wanakorn.ra@kmitl.ac.th

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Expert consensus on gepants for acute and preventive treatment of migraine in Thailand
(2025-12-01)
Anukoolwittaya, Prakit
;
Rattanawong, Wanakorn
;
Vongvaivanich, Kiratikorn
;
Pongpitakmetha, Thanakit
;
Thanprasertsuk, Sekh
Introduction: Gepants, a calcitonin gene-related peptide (CGRP) receptor antagonist, is a class of migraine therapeutic options with extensive evidence supporting a favorable efficacy and safety profile. However, as a novel class of medication in Thailand, specific guidelines or recommendations regarding rational drug use are currently unavailable. This could hinder physicians from utilizing the medications for eligible patients and prevent pharmacists from providing information to physicians and patients. Main body: In order to develop consensus-based statement recommendations, a modified Delphi approach was employed, which included two rounds of surveys, discussions, and voting. General recommendations were made, as well as specific recommendations of gepants in both acute and preventive treatment roles. Additionally, clinical settings where gepants could be suitable options were identified, along with the recommendations for their use in special populations and relevant precautions. Conclusion: Gepants can serve as both acute and preventive therapy for migraines. They provide an alternative to first-line therapies for patients with limitations to conventional agents, including contraindications or intolerance. Gepants can be utilized as monotherapy or in combination with other treatment approaches. Optimal prescribing practices for eligible patients could ensure that patients receive maximum benefit with minimal risk.
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CGRP-targeted therapy fulfilling the treatment gap in medication-underuse setting: a retrospective cohort study at a tertiary headache center in Thailand, a lower-middle-income country
(2025-12-01)
Roongrojwittayakul, Sirawit
;
Anukoolwittaya, Prakit
;
Hiransuthikul, Akarin
;
Pongpitakmetha, Thanakit
;
Thanprasertsuk, Sekh
Background: Migraine preventive treatment is essential to reducing the burden of disease. However, discontinuation of oral migraine preventive medications (OMPMs) remains common due to suboptimal efficacy and tolerability, especially in lower-middle-income countries, which may contribute to migraine progression—a situation that has led to the introduction of the concept of “Medication Underuse Headache”. The calcitonin gene-related peptide monoclonal antibody (CGRP mAbs) might close the gap in this situation. This study aimed to investigate the treatment patterns of migraine preventive medications over six months at a tertiary headache center in Thailand and to explore the association between each preventive medication class and discontinuation rates. Methods: A single-center retrospective cohort study was conducted between 2021 and 2023. Adult patients who were diagnosed with migraine and received at least one preventive medication at their first visit to the Headache Clinic at King Chulalongkorn Memorial Hospital were included, with a minimum follow-up period of six months. The primary outcome was the discontinuation of any migraine preventive medication from the baseline regimen during follow-up visits. A multivariable Cox regression model, adjusted for sex, age, and diagnosis, was used to explore baseline factors associated with the discontinuation of preventive migraine medications. Results: Among the 100 eligible patients (mean age [SD]: 39.6 [14.4] years; 87.0% female), 41.0% (41/100) discontinued at least one preventive medication, most commonly due to intolerance to side effects (53.7%, 22/41) and lack of treatment effectiveness (34.1%, 14/41). The highest discontinuation rates were observed with serotonin norepinephrine reuptake inhibitors at 53.8% (7/13), calcium channel blockers at 37.5% (6/16), and beta-blockers at 25.6% (11/43). Notably, no patients discontinued CGRP mAbs. Patients using CGRP mAbs at baseline had a significantly higher rate of discontinuing at least one other oral preventive medication compared to those who did not use CGRP mAbs: 31.7% vs. 25.4% at month 3, and 55.4% vs. 33.4% at month 6 (p = 0.04). After adjustment, baseline use of CGRP mAbs was significantly associated with an increased risk of discontinuing at least one medication in the regimen (adjusted odds ratio 2.16; 95% CI: 1.16 to 4.03, p = 0.02). Conclusion: Discontinuation of preventive migraine treatment remains a significant issue in Thailand. CGRP mAbs were associated with higher treatment persistence and may help reduce polypharmacy in migraine management.
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Factors contributing to inaccurate migraine diagnosis: a prospective study at a tertiary hospital in Southern Thailand
(2026-12-01)
Suwanlaong, Kanokrat
;
Sittisomwong, Sirianong
;
Dutsadeethammo, Duangkamon
;
Anukoolwittaya, Prakit
;
Rattanawong, Wanakorn
Background: Migraine is a common and disabling neurological disorder, yet diagnostic accuracy remains suboptimal, especially in non-specialist settings. Misdiagnosis may lead to delayed treatment, medication overuse, and reduced quality of life. The objective of this study was to estimate the proportion of patients with migraine attending the headache clinic who were misdiagnosed or not diagnosed as having migraine before attending the headache clinic, and to identify factors associated with inaccurate migraine diagnosis among patients before attending a tertiary hospital in Southern Thailand. Methods: A prospective, cross-sectional study was conducted at Songkhla Hospital between July 2024 and April 2025. Adult patients (≥ 18 years) with a final migraine diagnosis confirmed by two blinded independent neurologists were enrolled. Participants were divided into two groups: (1) an appropriate diagnosis group, defined as patients who received a correct diagnosis of migraine at their initial consultation with any physicians prior to attending the headache clinic; and (2) an inappropriate diagnosis group, defined as patients who were previously misdiagnosed with another headache disorder or had not been diagnosed with migraine before their headache clinic visit. Data on demographics, clinical features, and the specialty of the first attending physician were analyzed using univariable and multivariable logistic regression. Results: 90 patients were included (87.8% female, mean age 43.4 ± 14.8 years). 43.3% had been misdiagnosed at their initial visit. The most common incorrect diagnoses were tension-type headache and sinusitis. Multivariable analysis identified five independent factors significantly associated with inappropriate diagnosis: male sex (adjusted OR 7.77, 95% CI 1.07–56.50, p = 0.043), bilateral headache (aOR 3.90, 95% CI 1.25–12.13, p = 0.019), lack of worsening by physical activity (aOR 5.09, 95% CI 1.54–16.89, p = 0.008), presence of vertigo/dizziness (aOR 4.39, 95% CI 1.22–15.83, p = 0.024) and initial consultation with a non-neurologist (aOR 7.92, 95% CI 2.63–23.88, p < 0.001),. Conclusion: Misdiagnosis of migraine remains frequent in clinical practice, particularly among patients initially evaluated by non-neurologists. Atypical symptom profiles—such as bilateral pain, lack of activity-related exacerbation, or associated vertigo—contribute to diagnostic inaccuracy. Enhanced awareness and targeted education for primary physicians are essential to improve diagnostic precision and reduce treatment delay.

Rattanawong, Wanakorn

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