Optimizing Acute Migraine Care Improves Quality of Life and Reduces Disability

Dawn Buse, PhD, clinical professor of neurology, Albert Einstein College of Medicine, and assistant professor, Ferkauf Graduate School of Psychology, Yeshiva University

Dawn Buse, PhD

Data from the OVERCOME study in migraine suggests that the optimization of acute migraine treatment can not only reduce disability for patients with migraine but can also improve health-related quality of life.

Of the full cohort—which included 20,042 respondents&mdash;3938 respondents had between 4 and 7 migraine headache days per month, and 60.1% of those with very poor treatment optimization, determined by the Migraine Treatment Optimization Questionnaire (mTOQ), had severe Migraine Disability Assessment Scale (MIDAS) disability as opposed to only 19.5% of those with maximum treatment optimization (P <.001).

The study, conducted by Dawn Buse, PhD, clinical professor of neurology, Albert Einstein College of Medicine, and assistant professor, Ferkauf Graduate School of Psychology, Yeshiva University, and colleagues was scheduled to be presented at the American Academy of Neurology (AAN) 2020 Annual Meeting.

“Acute treatments for migraine attacks are considered optimized when they resolve pain and restore function,” Buse et al. wrote. “Optimized acute treatment for migraine should be associated with less disability and better health-related quality of life in people with migraine.”

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Additionally, the data suggest that those with very poor treatment optimization had significantly lower Migraine-Specific Quality of Life Questionnaire, Role Function—Restrictive subscale (MSQ-RFR) scores (mean, 32.0; standard deviation [SD], 22.8) relative to those with maximum treatment optimization (mean, 63.4; SD, 20.7; P <.001). There were statistically significant differences observed in MIDAS and MSQ-RFR scores by treatment optimization across all other migraine headache day cohorts (0—3 days, 8–14 days, and ≥15 day; P <.001 for all).

In July 2019, some of the data from OVERCOME were presented at the American Headache Society (AHS) Annual Meeting alongside data from the CaMEO study to indicate some of the trends in the treatment of patients with migraine across the United States. All told, the studies identified a number of interesting bits of information regarding how and where these individuals are receiving care and utilizing medications. One notable finding was that roughly 45% of patients with migraine sought care from their primary care physician—which is where the “overwhelming majority” of people will start seeking care, Buse told NeurologyLive at the time.

As well, that data, which focused on the sample of patients with ≥4 migraine headache days per month, revealed that in the preceding 12 months, 61.1% sought care for migraine—38.3% of which did so at more than 2 different types of health care providers. These provider types included primary care providers (45.5%), neurologists (20.2%), emergency medicine clinicians (19.2%), urgent care providers (14.4%), pain specialists (12.8%), headache specialists (12.0%), and retail non&#8208;urgent clinics (10.4%).²

Seeking care was observed to be positively associated with migraine headache days, pain severity, allodynia, aura, and prodrome (P <.001 for all), and among the migraine&#8208;related characteristics assessed, nausea/vomiting (68.8%) was more likely to lead to seeking care relative to phonophobia/photophobia (64.3%; P <.001).

Those who sought care at a headache specialist (55.0%) or a neurologist (50.1%) were most likely to be using a preventive migraine medication, though more than 20% of those seeking care at primary care, urgent care, or retail clinic were undiagnosed. Primary care doctors were found to be most likely to prescribe triptans, then opioids, and then preventive medications, while neurologists and headache specialists were most likely to prescribe preventive medications and were observed to be unlikely to prescribe opioids.

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REFERENCES

1. Buse D, Kovacik AJ, Nicholson RA, et al. Acute Treatment Optimization Influences Disability and Quality of Life in Migraine: Results of the ObserVational survey of the Epidemiology, tReatment and Care Of MigrainE (OVERCOME) Study. Neurology. 2020;94 (15 Suppl). 4154.

2. Buse D. Migraine Care Across the Healthcare Landscape in the United States Among Those with ≥4 Migraine Headache Days Per Month: Results of the OVERCOME Study. Presented at: 2019 American Headache Society Annual Meeting; July 11-14, 2019; Philadelphia, PA. Poster P60.