WASHINGTON, DC—More than 40% of patients with episodic migraine have at least one unmet treatment need, despite the availability of migraine-specific therapies, according to findings presented at the 53rd Annual Scientific Meeting of the American Headache Society. Having an unmet treatment need, researchers found, significantly increased the risk for anxiety and depression.
The research group was led by Richard B. Lipton, MD, Professor and Vice Chair of the Saul R. Korey Department of Neurology at the Albert Einstein College of Medicine and Director of the Montefiore Headache Center, and Dawn C. Buse, PhD, Assistant Professor in the Albert Einstein College of Medicine and Director of Behavioral Medicine at the Montefiore Headache Center in New York City. They analyzed patient responses to a 2009 survey from the American Migraine Prevalence and Prevention Study, a longitudinal population-based study of persons with severe headache, to define and quantify unmet treatment needs among persons with migraine.
“Despite the array of acute and preventive medications available, the minority of individuals with migraine use migraine-specific therapies,” Dr. Buse told Neurology Reviews. “Even among those who do use migraine-specific therapies, satisfaction with treatment was low to moderate. We found high levels of headache-related disability, frequent use of emergency department and urgent care clinics, and use of potentially addicting medications such as opioids. These findings suggest that there are many unmet needs among migraine patients.”
Five Indicators of Unmet Treatment Needs
Of the 5,591 patients with episodic migraine (defined as meeting ICHD-2 criteria for migraine and experiencing an average of fewer than 15 headache days per month) who responded to the 2009 survey and met criteria for inclusion in the study, 40.6% had at least one of the five indicators of unmet needs, and 14.4% had two or more unmet needs. More than half (59.4%) had no unmet needs. The researchers defined unmet treatment needs as: dissatisfaction with treatment, moderate to severe levels of headache-related disability, opioid and barbiturate overuse or dependence, excessive emergency department or urgent care center use, and a history of cardiovascular events that are contraindications to triptan use. The population was largely female (2,675 females and 642 males), and females comprised the majority of those patients reporting one or more unmet treatment needs.
The most commonly encountered unmet treatment needs were headache-related disability (19.2%), dissatisfaction with current medications (15.2%), and opioid or barbiturate overuse or dependence, defined as use on four or more days per month or meeting DSM-IV criteria for dependence (13.0%). Approximately 10% of patients had a history of cardiovascular events, and 2.3% had excessive use of emergency department or urgent care clinics, defined as two or more visits per year for headache.
Comparing Groups of Survey Respondents
A little more than 2% of respondents experienced all three of the most common unmet treatment needs, Dr. Buse noted. “These results demonstrate that persons with episodic migraine in the US population have unmet treatment needs despite the use of currently available therapies. The leading reasons for unmet needs include level of disability and satisfaction with current treatment,” she said.
“We then divided respondents into three groups and compared those with no unmet treatment needs versus persons with one or two or more unmet needs,” Dr. Buse continued. “Respondents with any number of unmet needs were more likely to be older, have higher BMI, and more headache days per month than those without unmet needs.” The mean age of those with one unmet treatment need was 51.8; it increased to 52.1 in those who reported two or more unmet needs. BMI was 29.4 in the no unmet needs group, 30.3 in the one unmet need group, and 30.8 in the two or more unmet needs group. Headache days increased similarly from 1.9 to 3.3 to 4.6.
Impact on Mental Health
“We found striking results for rates of psychiatric comorbidities, including depression and anxiety,” Dr. Buse commented. “Respondents with one versus no unmet treatment needs were 2.5 times more likely to meet DSM-IV criteria for anxiety.” Those with two or more unmet needs were 5.5 times more likely than those with no unmet needs to meet the criteria for anxiety.
Analysis for depression showed similar results. “Those with one unmet need were almost three times more likely to be depressed than those with no unmet needs, and those with two or more unmet needs were 6.5 times more likely to be depressed than those with no unmet needs,” the researchers reported.
“Our results demonstrate that persons with episodic migraine in the US population have unmet treatment needs despite the availability and/or use of currently available therapies,” Dr. Buse concluded. “The leading areas of unmet needs, including headache-related disability, dissatisfaction with current treatment, and use of opioids or barbiturates for migraine, suggest opportunities for improving outcomes for patients living with migraine. Health care providers who care for persons with migraine should ask about the effect of headache on occupational, academic, and social functioning—or headache-related disability. They should also be vigilant for symptoms of depression and anxiety and refer for treatment when appropriate.”