Many Migraineurs Forgo Prescription Pain Medication

Despite significant burden and symptoms, many individuals with migraine have never used acute prescription pain medication to treat the condition, according to study results published in Mayo Clinic Proceedings.

The Chronic Migraine Epidemiology and Outcomes study, an internet-based, cross-sectional longitudinal survey, collected data from 13,624 respondents between September 2012 and November 2013.

Researchers examining the data found that although migraine is a chronic and sometimes debilitating disease, a majority of respondents (64.5%) reported they had never used acute prescription medication for migraine.

“The main goals of the acute treatment of migraine attacks include rapidly treating the attack with minimal recurrence, reducing the use of additional rescue medications, restoring function, minimizing subsequent resource use, being cost-effective, and minimizing the occurrence of adverse events," the authors said.

Of the 13,524 respondents, 3121 (22.9%) self-reported they currently use acute prescription medication for migraine, while 1719 (12.6%) reported they were previous/discontinued users. The most commonly reported prescription medications used were triptans (47.2%), opioids (37.3%), nonsteroidal anti-inflammatory drugs (31.9%), and barbiturates (12.8%). The majority of respondents were female and white, while one-third had a body mass index indicating obesity.

The researchers also found “self-reported comorbid conditions were most common among current users, including cardiovascular and gastrointestinal comorbid conditions. A greater proportion of current users had moderate to severe levels of depression or anxiety than discontinued or never users.”

Current prescription medication users reported the highest mean (SD) monthly headache frequency, 7.3 (7.1) days, and highest degree of migraine-related disability and symptom severity based on the Migraine Disability Assessment.

Although individuals who took prescription medications self-reported more severe symptoms, the authors note the pain and disability of those who opted not to receive prescription medication is still clinically meaningful.

Nearly 30% of respondents who never used acute prescription medication reported they experienced moderate to severe migraine-related disability and "12% reported severely impaired function or a need for bed rest as a usual effect of headaches.” Based on responses to psychological questionnaires PHQ-9 and GAD-7, 33% of discontinued users reported moderate or /severe levels of depression, while another 30% reported moderate or severe anxiety respectively.

The most common reasons for not using acute prescription migraine medication were that headaches were not that serious, respondents experienced satisfactory responses to OTC medications, and respondents did not want to take a prescription medication.

“Many people who meet the criteria for migraine, especially younger people and men, have discontinued use of or have never received acute prescription medication for migraine despite relatively high rates of migraine-related burden,” the researchers concluded.

Due to the self-reporting nature of the survey, bias may be present in some respondents' answers and information provided cannot be verified.

Reference

Hutchinson S, Lipton RB, Ailani J, et al. Characterization of acute prescription migraine medication use: results from the CaMEO Study. Mayo Clin Proc Innov Qual Outcomes. 2020;95(4):709-718. doi: 10.1016/j.mayocp.2019.11.025.