Identifying and Quantifying Unmet Acute Treatment Needs in Adults With Migraine

Migraine in America Symptoms and Treatment (MAST) study respondents using acute oral prescription migraine treatments were generally similar to the total MAST sample, and at least 1 unmet need was reported by nearly all respondents.

A high number of adults in the United States with migraine who take acute oral prescription migraine medications report unmet treatment needs, including rapid headache onsets and moderate to severe disability, according to study results published in Headache. The study also found that as the number of unmet needs increased, symptom severity and the number of coexisting conditions also rose.

The study was a cross-sectional analysis of a sample of adults in the United States with migraine who participated in the Migraine in America Symptoms and Treatment Study in 2017. In the online survey, participants self-reported a history of ≥3 monthly headache days in the 3 months prior to enrollment and ≥1 monthly headache day in the previous 30 days. Only participants who reported current use of orally administered acute prescription headache medication were included in the analysis (n=3930; mean age, 45.0 years).

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During the survey, respondents reported inadequate treatment response (ie, inadequate 2-hour pain freedom and recurrence within 24 hours of initial relief), demanding attack characteristics (rapid onset of attack and headache associated with sleep), and unique patient characteristics (ie, opioid or barbiturate overuse and cardiovascular comorbidity) as the 3 main areas of unmet treatment needs.

In addition to identifying unmet treatment needs in these patients, the researchers also examined coexisting conditions and symptoms (ie, level of treatment optimization, psychological symptoms, attack-related cutaneous allodynia, and migraine symptom severity).

The majority of respondents to the survey reported ≥1 unmet treatment need (95.8%). Demanding attack characteristics, inadequate treatment response, and unique patient characteristics were reported in 89.5%, 74.1%, and 16.1% of participants, respectively.

The most frequently reported unmet needs included rapid headache onset (65.3%), moderate to severe disability (55.6%), inadequate 2-hour pain freedom (48.1%), and 24-hour headache recurrence (38.0%). Increasing unmet treatment needs correlated with worsening psychological symptoms as well as worsening attack-related cutaneous allodynia and severity of migraine symptoms.

Limitations of the study included the cross-sectional nature of the analysis, the survey’s self-reported outcome measures, and the lack of patient stratification by chronic migraine and episodic migraine.

The researchers wrote that identifying and “understanding unmet treatment needs with orally administered acute medications can be a useful framework for designing clinical trials, developing new treatments, optimizing treatment plans, and improving acute treatment outcomes for people with migraine.”

Disclosure: This study was funded and sponsored by the Dr. Reddy’s Laboratories. Several of the study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Lipton RB, Munjal S, Buse DC, et al. Unmet acute treatment needs from the 2017 Migraine in America Symptoms and Treatment study [published online August 13, 2019]. Headache. doi:10.1111/head.13588