Medication Adherence Suboptimal During Migraine Attacks

A significant amount of patients with migraines do not adhere to treatment with triptans during attacks.

WASHINGTON — Patients prescribed triptans for migraine do not adhere to treatment plans in over 40% of migraine attacks, according to study data presented at the American Headache Society Annual Scientific Meeting in Washington, D.C.

Triptans, or other migraine-specific medications, are considered the best first-line defense against migraine attacks. However, Robert A. Nicholson, PhD, LCP, FAHS, of Mercy Clinic Headache Center & Mercy Health Research in St. Louis, and colleagues found that participants reported taking triptans in only 57.2% of cases and were more likely to do so when pain was mild rather than moderate or severe.

Despite its importance to migraine treatment, there is a dearth of studies that investigate rates of medication adherence among migraine patients. In this study, the researchers wanted to determine the rates of triptan adherence during migraine attacks, assessing data in real and near time across several attacks.

The study included 267 participants with migraine who had been prescribed a triptan. Each participant completed a web-based headache diary every day for at least 30 days. If the participant reported a headache, the diary assessed variables including headache severity, headache duration, associated International Classification of Headache Disorders (ICHD) symptoms, acute medication use, and attack disability as measured by the Migraine Disability Index (MIDI). The researchers only assessed the days in which participants had a migraine, probable migraine, or treated the headache with a triptan (n=7,497).

The researchers found that 4,291 (57.2%) of migraines in the study were treated with a triptan. On days when a triptan was taken, the average amount of reported disability was significantly lower compared with days where a triptan was not taken.

Adherence to triptans was higher when participants reported mild pain severity (56%) compared with when they reported moderate (43%) or severe (39%) pain. It was also higher when participants had nausea (49% yes vs. 42% no), photophobia (50% yes vs. 42% no), pulsating/throbbing pain (53% yes vs. 39% no), or unilateral pain (53% yes vs. 39%).

The researchers suggest educating patients on the benefits of medication for migraines in order to encourage higher rates of triptan adherence.


  1. Nicholson RA et al Abstract 89682: Longitudinal Real and Near-Time Assessment of Acute Medication Adherence During Migraine Attacks. Presented at: American Headache Society Annual Scientific Meeting; June 18-21, 2015; Washington, D.C.