For patients with migraines, the most common reasons reported for discontinuing acute prescription medications were lack of efficacy, apprehension over tolerability, exchanging for a different form of treatment, and financial concerns, according to a study published in Headache.

The aim of this study was to assess the frequency, the thematic reasons, and the migraine burden of patients who discontinue the use of acute prescription medications for migraines. Data for this study were obtained from the longitudinal, internet-based survey completed for the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study, and this analysis only included patients who discontinued their prescribed acute medication for migraines. Survey data were collected at baseline in 3-month intervals between September 2012 and November 2013. Data collected included information on the characteristics of the migraines to assess endophenotypes and allodynia, the reasons why the patients discontinued medication (patient could pick more than 1 reason), the last time they used the medication, and how long they used the medication before discontinuation. Other assessments used were the Migraine Disability Assessment, Patient Health Questionnaire 9-item depression screener, Generalized Anxiety Disorder 7-item screener, and the 12-item Allodynia Symptom Checklist.

Of the 4840 patients who completed the survey and had used acute prescription medications for migraines, 35.5% (N=1719) had discontinued using the medication. For this group, the mean age was 42.1 years, 78.4% were women, 65.6% were overweight or obese, 84.6% had healthcare insurance coverage, and 87.5% were not currently consulting with a healthcare professional about their headaches. In regards to headache characteristics, 50% of the patients had allodynia, 37.6% had ≥5 headache days per month, and 67.5% had received a migraine diagnosis from a doctor or other healthcare professional. In regards to work, 19.1% reported the ability to function normally, 59.5% reported impaired ability to function, 10.8% reported severe impairment to functionality, and 10.6% reported that they required bed rest. In addition, 33.0% of these patients exhibited severe depression and 30.0% exhibited moderate to severe anxiety. 

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Reasons for discontinuing the acute prescription medication included switching to alternative treatments (45.5%), lack of efficacy (28.2%), tolerability or safety concerns (24.9%), improvements in headaches (21.3%), and financial reasons (19.4%). Many patients had overlapping reasons for discontinuing their medication and the 2 most common were the lack of efficacy and tolerability concerns. Severe migraine disability occurred in 41.9% of patients who switched to preventative medication, 37.9% of patients who discontinued due to doctor’s instructions, 33.9% of patients who had financial concerns, and 64.4% of patients who discontinued for both efficacy and tolerability concerns.

Limitations of this study include all data being self-reported, potential recall bias, and not subcategorizing patients by acute treatment type.

The researchers concluded that there is “a high level of disability and unmet treatment need among those with migraine who discontinue acute prescription medication for migraine” and “[a]ddressing efficacy and safety concerns commonly associated with these medications may help to improve treatment adherence, improve outcomes for patients, and mitigate the societal burden of migraine.”

Disclosure: This clinical trial was supported by Allergan plc. Several study authors declared affiliations with the pharmaceutical industry. 

Reference

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 [published online September 22, 2019]. Headache. doi: 10.1111/head.13642