LOS ANGELES—Migraine treatment regimens fall short of providing rapid and consistent relief, restoring patients’ ability to function, and reducing the risk of migraine recurrence, according to research presented at the 54th Annual Scientific Meeting of the American Headache Society.
Many patients taking prescription drugs for migraine are not getting the optimal benefits from their treatment, said Richard Lipton, MD, Lowe Professor and Vice Chair of Neurology at the Albert Einstein College of Medicine in Bronx, New York. Furthermore, treatment optimization was better for patients with episodic migraine than for patients with chronic migraine, as measured by the Migraine Treatment Optimization Questionnaire-5 (M-TOQ-5). Higher scores on the questionnaire reflect better treatment.
The mean M-TOQ-5 score for episodic migraine (4.01) was approximately 0.5 SD higher than that for chronic migraine (3.25). The difference between the two scaled optimization mean scores remained significant after the researchers adjusted the data for potentially confounding factors such as age and gender.
Patient Reports Help Researchers Analyze Treatment Optimization
Dr. Lipton and his colleagues assessed acute treatment optimization by analyzing data from 8,612 respondents to the American Migraine Prevalence and Prevention study. A total of 539 patients had chronic migraine, and 8,073 patients had episodic migraine.
Study participants completed the M-TOQ-5, a patient self-reporting tool that assesses treatment optimization in terms of functioning, rapid relief, consistent relief, risk of recurrence, and medication tolerability. Patients also answered questions about perceived control of symptoms and lack of disruption in daily activities. The researchers changed the questionnaire’s yes-or-no questions into statements that respondents rated as “never,” “rarely,” “less than half the time,” and “half the time or more.”
The M-TOQ-5 formed the basis of an Item Response Theory (IRT) model that defined scaled treatment optimization scores. Low scores indicated less optimization, and high scores indicated more optimization. The investigators expanded the IRT model to compare scores between patients with chronic migraine and those with episodic migraine.
Therapy Less Effective for Chronic Migraine Than for Episodic Migraine
Overall, differences between the numbers of patients who rated statements “half the time or more” and patients who rated statements “less than half the time” were greater among patients with episodic migraine than among patients with chronic migraine. Among patients with episodic migraine, 52% quickly returned to their normal activities half the time or more after taking migraine medication, compared with nearly 32% who resumed normal activities less than half the time after taking medication. For patients with chronic migraine, the corresponding figures were 42.3% and 35.0%, respectively.
Nearly 45% of patients with episodic migraine were pain-free half the time or more within two hours of taking migraine medication, compared with nearly 30% who were pain-free less than half the time. Approximately 35% of patients with chronic migraine were pain-free half the time or more within two hours of taking migraine medication, compared with approximately 30% who were pain-free less than half the time within two hours of taking migraine medication.
—Erik Greb
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