Predictors of Poor Treatment Response in Episodic Migraine

Over 50% of participants reported having an inadequate response to treatment.

Patients with frequent headache, depression, and medication overuse are more likely to witness headache return after treatment of episodic migraine.

Results from the subanalysis of the American Migraine Prevalence and Prevention Study (AMPP) were presented at the 2016 Annual Meeting of the American Headache Society in San Diego, CA.

With rapid pain relief rated as very important to migraineurs, the ability to characterize patients who may not have an adequate response to treatment is equally important for clinical decision-making.

The study, led by Richard B. Lipton, MD, of Albert Einstein Medical College, analyzed survey data from 8333 respondents with migraine. Participants were asked about their initial response to treatment (2 hours pain-free [2hPF]) and whether they achieved a sustained response (24 hour pain response [24hSPR]).

Among participants who were 2hPF (44%, n=3667; 82% female, mean age= 47 years), 74.3% (n=2689) had adequate 24hSPR compared to 25.7% (932) who had inadequate 25hSPR. Significant predictors of inadequate response were higher monthly headache frequency (OR 1.06, 95% CI 1.04-1.07 for each increase in headache), allodynia (OR 1.55, 95% CI 1.30-1.84), clinical depression (OR 1.48, 95% CI 1.19-1.84) and medication overuse (OR 1.29, 95% CI 1.06-1.59). Insurance status, BMI, weekly alcohol consumption, and headache pain severity were not significant predictors of treatment response.

Ultimately, approximately 56% of participants did not achieve an adequate 2hPF response for most migraine attacks. Clinicians should focus on assessing and improving treatment response in all patients, particularly those that present with predictors of inadequate response.

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Munjal S, Reed ML, Bennett A, Buse DC, Fanning KM, Liption RB. Abstract PF02. Predictors of Inadequate 24-Hour Sustained Response to Medication in Episodic Migraine (EM): Results from American Migraine Prevalence and Prevention Study (AMPP). Presented at: 2016 American Headache Society Annual Meeting. June 9-12, 2016; San Diego, CA.