Study Assesses Migraineur, General Practitioner Viewpoints on Treatment Variables

When prompted to consider different variables related to acute and preventive treatment for migraine, patients and general practitioners (GPs) largely agreed on the most and least important end points.

According to study findings published in BMC Neurology, the most important end points for acute treatment were effectiveness, a short action time, and a persistent effect, while effectiveness, sustained effect, and tolerability were most important for prophylactic therapy.

“In the validation of acute and preventive medications, the International Headache Society (IHS) recommends harmonizing and standardizing the employed endpoints through IHS guidelines,” researchers explained. “However, success is a matter of perspective and the endpoints that have been selected may not be fully accepted by patients or GPs."

To better understand which end points are considered most important by patients and GPs, and to study the optimal efficacy and action time in symptomatic and preventive treatments, investigators carried out an observational descriptive study in each sample (patients and GPs).

All patients with migraine (n = 55) were aged 18 or older and had a diagnosis of episodic migraine. GPs (n = 55) were recruited via institutional mail reach outs and practiced in the same geographical area as the researchers. The study took place in Spain between April and May 2018.

Study participants were given a list of end points and asked to rate each variable about acute and preventive treatment on a 0-10 scale—where 0 was defined as worst possible and 10 as best possible. Participants were also asked to select the 3 most important variables and least important end points.

Analyses revealed:

• Effectiveness was considered the most important variable for symptomatic and preventive treatment.
• Cost was considered the least important variable
• Patients’ desired percentage of efficacy was 84% (SD 16.7%) for symptomatic treatment and 79.9% (17.1%) for preventive treatment
• GPs’ desired percentage of efficacy was 75% (14%) for symptomatic treatment and 70.4% (14.3%) for preventive treatment.
• For symptomatic treatment, the desired action time for pain cessation was selected as 27.5 minutes (13.8) for patients and 24 minutes (18.3) for GPs
• For preventive treatment the desired action time for effect was 7.1 days (4.5) for patients and 13.9 days (8.9) for general practitioners

“The level of a patient’s satisfaction and their perception of treatment success usually depends on their previous expectations,” authors explained. “There is generally a gap between what the patient expects from the treatment and the real result. The smaller this gap is, the higher level of satisfaction.”

Because most scores reported by the GPs in the current study were lower than those of patients, this finding could reflect better knowledge of existing treatments among GPs. Therefore, providing patients with information including realistic expectations of current treatments might improve patient satisfaction, according to the researchers.

Findings also revealed action time is perceived as important for patients, but this factor is not frequently considered in clinical trials. Based on this finding “further research is needed to develop novel drugs with higher efficacy rates and shorter action time,” the authors concluded.

Reference

Trigo-López J, Guerrero-Peral ÁL, Sierra Á, et al. Patients and general practitioners assessment of the main outcomes employed in the acute and preventive treatment of migraine: a cross sectional study. BMC Neurol. Published online July 15, 2021. doi:10.1186/s12883-021-02220-w