NEW ORLEANS—Most patients with migraine either have never tried prophylactic medications or have tried several such drugs, suggesting that current therapies are not meeting patients’ needs, researchers reported at the 64th Annual Meeting of the American Academy of Neurology.
Compared with patients with episodic migraine, those with chronic migraine are more severely disabled and have more recent visits to headache-
related health care providers, emergency rooms, and hospitals. Patients with chronic migraine thus have a greater need for migraine prophylaxis than patients with episodic migraine, but they are less satisfied with their treatments and experience less improvement, according to Joanna C. Sanderson, PharmD, a postdoctoral fellow at the University of Washington School of Pharmacy in Seattle.
Examining Patients’ Use of and Attitude Toward Prophylactic Drugs
Prophylaxis therapies can lessen the frequency and severity of migraines, but a recent study concluded that these drugs are underused. Dr. Sanderson analyzed responses to the second International Burden of Migraine Study, a web-based survey, to assess the use patterns of and attitude toward migraine prophylaxis therapy among patients with chronic and episodic migraine. Responses came from the United States, Canada, France, Germany, the United Kingdom, and Australia.
Eligible patients were 18 or older, reported one or more headaches during the past three months, and had symptoms that met the diagnostic criteria for migraine. Respondents were characterized as having episodic or chronic migraine, based on their reported headache frequencies. Participants described their current and past use of antidepressants, antiepileptics, beta-blockers, and calcium-channel blockers for migraine prophylaxis. Each respondent also rated his or her satisfaction with the medication, his or her level of improvement, and the degree to which side effects were bothersome.
A total of 1,165 respondents completed the questionnaire. Patients’ mean age was approximately 43, and approximately 75% were female. A plurality of patients (nearly 37%) was from the United States.
Patients With Chronic Migraine Were Less Satisfied With Prophylaxis
Among the 493 patients with chronic migraine, 84% had severe or very severe disability. In contrast, 24% of patients with episodic migraine had severe or very severe disability, and 76% had little, mild, or moderate disability.
Approximately 63% of patients with chronic migraine reported having ever used prophylaxis therapy, compared with 40% of patients with episodic migraine. About 46% of patients with chronic migraine reported having tried more than one prophylaxis therapy, compared with 23% of patients with episodic migraine.
Overall, patients with chronic migraine were less satisfied with prophylaxis therapy, and this result was statistically significant for antiepileptic agents. Patients with chronic migraine appeared to express more satisfaction with beta-blockers than with the other classes of drugs studied, but the researchers could not compare levels of satisfaction with different agents using statistical testing because some respondents were taking multiple agents. In addition, patients with chronic migraine reported less improvement than patients with episodic migraine. This result was statistically significant for antidepressants, antiepileptic agents, and beta-blockers. The degree to which side effects were bothersome was similar between patients with chronic migraine and those with episodic migraine.
Headache improvement was the strongest predictor of satisfaction with prophylaxis therapy, and patients with episodic migraine were more likely to be satisfied with their therapy. Having a pain specialist as a typical provider of headache care was strongly correlated with satisfaction. On the other hand, having a neurologist as a typical provider of headache care was the strongest predictor of headache improvement.
“Researching methods of increasing satisfaction is important,” Dr. Sanderson told Neurology Reviews. Investigators should examine whether an intervention focused on teaching patients the differences between prophylaxis and abortive medications, and on the importance of adherence to prophylaxis therapy, would improve satisfaction, she added.
Färkkilä M, Diener HC, Géraud G, et al. Efficacy and tolerability of lasmiditan, an oral 5-HT(1F) receptor agonist, for the acute treatment of migraine: a phase 2 randomised, placebo-controlled, parallel-group, dose-ranging study. Lancet Neurol. 2012;11(5):405-413.