Study Calls for More Effective Prophylactic Treatments for Migraine

A recent retrospective study looked to evaluate long-term treatment patterns in patients with migraine initiating prophylactic therapy, as well as acute medication use and adverse events associated with opioids.

The study reviewed administrative claims data from 147,832 patients who began prophylactic medication between 2005 and 2014. The study included patients with at least 1 inpatient claim, at least 1 emergency department claim, or at least 2 outpatient claims with a migraine diagnosis; at least 1 outpatient claim with a migraine diagnosis and at least 1 outpatient pharmacy claim for a prophylactic migraine drug; or at least 2 outpatient pharmacy claims for a triptan or ergotamine and initiation of a prophylactic migraine medication.

The study authors then analyzed the treatment patterns during the follow-up period and included the number of patients beginning prophylactic treatment for migraine; treatment persistence, which was defined as the continuous use of the drug without a gap of more than 60 days from when the prior prescription ran out; and treatment nonpersistence, which was defined as a gap of more than 60 days in supply from when the prior prescription ran out.

Overall, the researchers found that persistence of treatment was seen in 9.7% of patients (n = 14,314), whereas nonpersistence was observed in 90.3% of patients (n = 133,518). This was due to patients switching to a different prophylactic treatment for migraine (n = 51,981), restarting treatment after a gap of more than 60 days (n = 40,136), or discontinuation (n = 41,401).

Additionally, the authors found that during the follow-up period, nearly 60% of patients received triptans, 66.6% received nonsteroidal anti-inflammatory drugs, 77.4% received steroids, and 2.6% received ergotamines.

In the analysis of the incidence of adverse events related to patients with migraine treated with opioids, 27.7% (n = 49,676) of patients experienced gastrointestinal adverse events.

Overall, the authors found that nonpersistence to prophylactic migraine treatment was common among the participants. “Opioid use was common in migraine patients and the risk of gastrointestinal adverse events and opioid abuse increased with long-term use of opioids. These results suggest a need for more effective prophylactic migraine treatments,” wrote the authors.

Reference

Bonafede M, Wilson K, Xue F. Long-term treatment patterns of prophylactic and acute migraine medications and incidence of opioid-related adverse events in patients with migraine [published online February 28, 2019]. Cephalalgia. doi: 10.1177/0333102419835465.