PHILADELPHIA—Results of a survey of treatment expectations at first visit indicated that patients with migraine “in general tended not to expect a cure for their headaches and, interestingly, differentiated between cure and symptom control,” Leslie Kelman, MD, reported at the 47th Annual Scientific Meeting of the American Headache Society. Dr. Kelman, Medical Director of the Headache Center of Atlanta, reported data from a survey of 1,207 migraineurs with and without aura and of patients with chronic migraine.

Approximately 86% of the subjects were female. Mean age in the study cohort was 38.2, mean lifetime duration of headache was 14.9 years, and mean frequency of headaches per month was 12.7. This group of migraine patients was compared with a group of 539 probable migraine patients.

Information regarding demographics, prodrome, postdrome, aura, headache characteristics, medication responsiveness, acute and chronic disability, sleep characteristics, and social and personal characteristics was obtained at the patient’s first office visit. During that same visit, all patients were asked the following five questions:

• Are you expecting a cure for your migraine?
• Are you expecting to be symptom-free with treatment?
• Are you expecting a reduction in frequency of your migraine headaches?
• Are you expecting a reduction in the severity of your headaches?
• Are you expecting an improvement in the quality of your life?

Dr. Kelman found that only 27.8% of patients expected a cure from their treatment. About 80% expected to become symptom-free with treatment, and 95% expected reduced headache frequency, reduced headache severity, and improved quality of life, Dr. Kelman reported. There were no between- group response differences for gender or headache type. Patients with longer lifetime headache duration were more likely to expect a cure, and those with higher headache frequency were less likely to expect improvements of any kind.

“Headache duration—but not severity—was correlated with expectation of reduction in severity of headache. Number of severe days was negatively correlated with expectations of cure, improved quality of life, reduced headache frequency, and reduced severity,” Dr. Kelman said. “Missed social activity days were negatively correlated with expectation of cure, improved quality of life, and reduced severity of headache.”

PATIENTS WANT GREATER INPUT IN CHOOSING MIGRAINE THERAPY

Both male and female patients with migraine reported that having a physician who involves them in the process of choosing a preventive headache medication is the single most important element in preventive treatment, according to Todd D. Rozen, MD, a Clinical Associate Professor of Neurology at Wayne State University, Detroit.

Dr. Rozen surveyed 150 migraineurs (114 female) in an effort to increase the use of preventive medications, now estimated to be needed by 50% of migraine patients but used by only 10%. “The reason for this may be lack of recognition of migraine-related disability by physicians, but there is also a barrier created by the patient to taking daily medication. The goal of this study was to try to better understand what patients want from their preventive medication so that physicians may be more successful at providing migraine prevention for individuals who need it,” Dr. Rozen said at the 47th Annual Scientific Meeting of the American Headache Society.

Patients were asked to rank the importance of 10 factors in migraine treatment. The mean ranking of each characteristic was calculated and used to establish an overall ranking for the entire set. “In this migraine preventive treatment survey, the most important thing to migraineurs is that the physician involves them in the decision-making process of choosing a preventive agent,” Dr. Rozen said. Men and women differed on the second most important factor. Men chose “published efficacy in the literature,” while women felt that having a physician who took the time to discuss possible side effects was more important.

“Migraineurs do not mind taking more than one preventive agent at one time if greater efficacy can be achieved. [Concern that certain agents will] affect weight and/or cause sedation may be important factors as to why patients do not want to take a particular preventive,” Dr. Rozen said. Once-daily dosing and the use of “natural therapy” such as vitamins and herbs were less important, ranking seventh and ninth of the 10 choices, respectively.

NR

—Janis Kelly

Suggested Reading
Lanteri-Minet M. What do patients want from their acute migraine therapy? Eur Neurol. 2005;53(suppl 1):3-9.
Gallagher R. What do patients want from acute migraine treatment? Cephalalgia. 2004;24(suppl 2):8-15.
Patrick DL, Martin ML, Bushmell DM, Pesa J. Measuring satisfaction with migraine treatment: expectations, importance, outcomes, and global ratings. Clin Ther. 2003;25:2920-2935.

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