Pain Relief Valued Over Other Treatment Attributes in Acute Episodic Migraine

Patients with acute episodic migraine consistently prioritize pain relief over other treatment attributes such as route of administration, adverse outcomes, and costs, according to study results published in Annals of Internal Medicine.

In support of American College of Physicians (ACP) guideline development on pharmacologic treatments for acute migraine, researchers performed a rapid review to assess patient values and preferences regarding acute migraine medication outcomes and attributes. They searched MEDLINE and CINAHL from inception through October 17, 2024 for relevant studies. Data were synthesized narratively and analyzed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) and GRADE-Confidence in the Evidence from Reviews of Qualitative Research to assess certainty of evidence.

A total of 17 studies were included in the review, representing 6568 unique patients. The patient population predominantly comprised women aged 35 to 47 years.

Across the studies, patients consistently prioritized treatment effectiveness for pain relief over harms, convenience, and other treatment attributes. In 11 studies (n=5235), pain relief was rated as more important than avoiding adverse effects (moderate-certainty evidence), and in 9 studies (n=3184), pain relief was valued more than relief of nausea, photophobia, and other concomitant symptoms (moderate-certainty evidence). Attributes such as medication convenience, cost, and route of administration were consistently rated lower in importance than pain relief.

Data captured from 7 studies (n=4421) showed that speed of medication onset was preferred over pain relief (low-certainty evidence). In 4 studies (n=688), patients consistently ranked relief of nausea above other symptoms, including photophobia, vision problems, fatigue, and irritability (moderate-certainty evidence). Three studies (n=1337) indicated oral medications were favored over other routes of administration (low-certainty evidence), and 3 other studies (n=1169) indicated cost as a less important factor than all other treatment outcomes (moderate-certainty evidence).

Although a single qualitative study of 20 patients revealed that treatment decisions were influenced by symptom severity, environmental context, and perceived drug benefits or drawbacks, the certainty of evidence was rated as insufficient.

Two studies (n=613) suggested that women may place more value on rapid pain relief and avoiding nausea than men, and 1 study (n=466) suggested age had no effect on patients’ treatment preferences. However, there was insufficient evidence for both of these findings.

Limitations of this analysis include variable study quality, low or insufficient certainty of evidence, potential lack of generalizability to younger and older populations, and the use of data from studies published up to 29 years ago.

According to the researchers, “This systematic review provides evidence for the ACP expert panel to incorporate regarding patients’ values and preferences in their recommendations on the pharmacologic treatment of acute attacks of episodic migraine.”

Disclosure: One study author reported affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

This article originally appeared on Clinical Pain Advisor