Treatment Optimization in Chronic Migraine Seen as ‘Poor’ Among Patients

Treatment optimization is reported to be “poor” among patients with migraine, with approximately 12% discontinuing treatment with triptans due to lack of efficacy and inadequate tolerability. These are the findings of a study presented at the 2024 American Academy of Neurology (AAN) annual meeting, held from April 13 to 18, 2024, in Denver, Colorado.

Suboptimal management of migraine may result in disease progression. Therefore, researchers of the Chronic Migraine Epidemiology and Outcomes — International (CaMEO-I) study aimed to assess gaps in the treatment optimization of migraine. Specifically, they analyzed 3 areas: acute medication overuse; history of medications and reasons for treatment discontinuation; and perceptions of treatment efficacy and tolerability.

The Migraine Treatment Optimization Questionnaire (mTOQ)-4 was used to determine treatment efficacy, with total scores categorized as very poor, poor, moderate, or maximum.

Between 2021 and 2022, a web-based survey was sent to adult participants with migraine, diagnosed using the modified International Classification for Headache Disorders (ICHD)-3 criteria, across 6 countries.

A total of 2404 patients with migraine were identified in the US, of whom 2226 received medications for their condition. Of these, 561 (25.2%) reported medication overuse, with 371 (66.1%) having scores ranging from very poor to poor for treatment optimization.

Of the US cohort, 653 (27.2%) discontinued use of at least 1 triptan; 270 (11.2%) entirely discontinued use of triptans, the majority (37.0%) of whom cited lack of treatment efficacy as the most common reason for discontinuation.

A total of 585 patients continued to receive treatment with triptans, of whom 390 (66.6%) received further questions on the survey on efficacy and tolerability of these medications. The majority of these respondents (60.5%) reported pain freedom within 2 hours of triptan use at half the time or less or never/rarely, followed by 39.3% who reported side effects or inadequate tolerability. Overall, 349 (59.7%) triptan users had scores of very poor to poor for treatment optimization.

“In a representative US sample of people with migraine who received triptans, 11.2% discontinued them. Among those who remain on triptans, treatment optimization is generally poor, due to lack of efficacy and poor tolerability,” the researchers concluded.