CHICAGO—Despite the benefits of early intervention, many patients with migraine delay treatment, reported Richard B. Lipton, MD, and colleagues at the 60th Annual Meeting of the American Academy of Neurology. Furthermore, many patients with migraine use multiple medications for acute treatment of headache attacks, they said.
Survey of Migraine Treatment Patterns
Persons eligible for participation were continuously enrolled in a health plan and had either a medical claim for headache or migraine or a pharmacy claim for migraine-specific medications (ie, triptans or ergots). Dr. Lipton’s research team asked participants to complete a mail survey and a follow-up telephone interview, both of which assessed treatment patterns. A total of 425 people (85% were female) completed the surveys/interviews.
Results showed that 33% of participants waited until they had moderate or severe pain before initiating treatment, while 26% waited until they were “sure it was migraine”; 40% took medication at the first sign of a headache attack, when the pain is mild. When asked what “early treatment” meant to them, 36% said “taking your medication at the first sign of a migraine/headache”; 32% said “taking your medication as soon as the pain is bad enough”; 21% said “taking your medication as soon as you experience a migraine symptom”; 8% said “taking your medication within a short time of migraine/headache onset”; and 3% reported other definitions.
Use of Multiple Medications
According to Dr. Lipton, Professor of Neurology, Psychiatry and Behavioral Sciences, and Epidemiology and Population Health at Albert Einstein College of Medicine, Bronx, New York, 71% of patients said they had taken multiple acute medications to treat their migraines; 65% had used multiple acute medications sequentially, and 28% had taken multiple medications simultaneously. Among those who took multiple medications simultaneously, 27% combined triptans with NSAIDs, and 41% combined triptans with “other” medications (ie, barbiturates, ergots, or opiates). Among those who took multiple medications sequentially, 55% reported step-care within attack, and 17% used rescue medication. Overall, 60% of triptan users began treatment with a nontriptan medication, noted the researchers. Patients’ reasons for multiple medication use included “takes a while to know if the headache is severe” (52%), “health insurance provides inadequate coverage” (44%), inadequate pain relief (15%), and other reasons (26%).
“Further research needs to be conducted to fully understand the reasons for the lack of use of early intervention by migraineurs as well as the economic impacts of this treatment practice,” Dr. Lipton’s group concluded.
—Karen L. Spittler