Results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study show that people who discontinue their acute prescription medication for migraine have a high level of unmet treatment need.1Scientists draw this conclusion in Headache. A lack of efficacy and concerns over safety and tolerability seem to be the most common reasons for discontinuation of acute prescription medication.

Prior research has demonstrated that acute medical treatment of migraine attacks is often suboptimal and that many migraine patients discontinue using them or switch to alternative options because they are not satisfied with their current medication. Understanding why patients are dissatisfied with their treatment could help to identify unmet treatment needs. Addressing those needs could in turn lead to better treatment and improved outcomes.

The CaMEO study aimed to investigate migraine-related burden and treatment decisions using a longitudinal, internet-based survey that identified and followed people with migraine who discontinued acute prescription medication. Respondents were asked to answer questions about the length of time since last use and reasons for discontinuation. Additional outcome measures included the monthly headache day frequency, the Migraine Disability Assessment (MIDAS), the Patient Health Questionnaire 9-item depression screener (PHQ-9), the Generalized Anxiety Disorder 7-item screener (GAD-7), and the 12-item Allodynia Symptom Checklist (ASC-12).

A total of 1719 discontinued users responded to the survey and were included in the analysis. The majority of them (62.4%) reported a monthly headache frequency of 0-4 days and more than half (50.4%) reported the presence of allodynia (ASC-12). Only about one in five (19.1%) patients were able to work or function normally with headache and 41.7% scored within the moderate to severe disability range at baseline (MIDAS). Moreover, roughly one-third suffered from moderate to severe depression (33.0%; PHQ-9) and/or anxiety (30.0%; GAD-7).

The most commonly reported (45,5%) reason for discontinuation of acute prescription medication – more than one answer was allowed – was a switch to non-prescription medication or alternative treatment options, followed by concerns about lack of efficacy (28.2%) and safety and/or tolerability (24.9%). More than one in five people (21.3%) stopped treatment because their headaches had improved. High rates of moderate to severe disability were found among people who discontinued for both efficacy and safety/tolerability concerns (64.4%).

According to the authors, these results further confirm a high level of disability and unmet treatment need in migraine patients who discontinue their acute prescription medication. In their view, addressing efficacy and safety concerns could improve treatment adherence and patient outcomes.

Reference

1. Lipton RB, Hutchinson S, Ailani J, et al. Discontinuation of acute prescription medication for migraine: results from the chronic migraine epidemiology and outcomes (CaMEO) study. Headache 2019;0:2-11. Doi: 10.1111/head.13642.
BE/NEUR/19/0009d/TevaPharmaBelgium/01.2020