Conference Coverage
SAN DIEGO—Sustained 24-hour pain relief is common among migraineurs who achieve pain freedom two hours after treatment, according to research presented at the 58th Annual Scientific Meeting of the American Headache Society. Factors that may predict recurrent headache after two-hour pain freedom include high headache frequency, allodynia, depression, and medication overuse.
Patients with migraine report that rapid pain relief without recurrence is an important outcome. Sagar Munjal, MD, Senior Director at Promius Pharma, a subsidiary of Dr. Reddy’s Laboratories in Princeton, New Jersey, and colleagues examined data from the American Migraine Prevalence and Prevention Study to identify predictors of two-hour pain freedom and 24-hour sustained response to treatment.
Sagar Munjal, MD
The researchers specifically analyzed responses to two questions from the 2006 survey. The first question was, “After taking your migraine medication, are you pain-free within two hours for most attacks?” The second question was, “Does one dose usually relieve your headache and keep it away for at least 24 hours?” Participants who reported two-hour pain freedom and responded “half the time or more” to the second question were considered to have adequate 24-hour sustained pain relief. Participants who reported two-hour pain freedom and responded “never,” “rarely,” or “less than half the time” to the second question were considered to have inadequate sustained relief.
Dr. Munjal and colleagues used separate binary logistic regression models to evaluate sociodemographics, lifestyle characteristics, headache features, and treatment patterns. They removed variables that were not associated with the outcome from the final model. The factors that remained in the final model were age, gender, marital status, smoking status, allodynia, monthly headache frequency, migraine symptom severity, depression, and medication overuse.
The investigators examined data for 8,333 migraineurs age 18 or older. Approximately 44% of participants reported two-hour pain freedom. Of this population, 82% were female, and the mean age was 47. Among participants with two-hour pain freedom, about 74% reported 24-hour sustained pain relief.
Average headache pain intensity was the main variable that predicted two-hour pain freedom. Allodynia, depression, preventive migraine medication, BMI, female sex, and marital status also predicted two-hour pain freedom. The results indicate the desirability of a fast-acting medication that patients can take early or before pain intensity becomes severe, said Dr. Munjal.
In descending order of significance, predictors of inadequate sustained response were allodynia (odds ratio [OR], 1.55), depression (OR, 1.48), medication overuse (OR, 1.29), and higher monthly headache frequency (OR, 1.06). Insurance status, BMI, number of alcoholic beverages consumed per week, and headache pain severity were removed from the model for nonsignificance.
“These results underscore that unmet need exists for acute migraine treatment in the United States, especially among people with certain sociodemographic and headache characteristics,” said Dr. Munjal. “These data also supplement recent findings that poor treatment optimization is associated with increased risk of chronic migraine onset among people with episodic migraine.”
—Erik Greb