Do Migraine Patients Reach Sustained Pain Relief?

There was a high rate of unmet treatment needs in people with migraine, according to the results of a recent study published in Headache. The study showed that more than one-half of people with episodic migraine surveyed had inadequate response to their regular acute treatment at 2 hours, and more than one-half had inadequate 24-hour pain response.

“These results show that unmet needs remain and the expansion of therapeutic options for episodic migraine is needed as well as optimizing treatment by carefully designing comprehensive treatment plans with existing acute therapies with various doses, routes of administration, preventive and interventional treatment approaches, behavioral therapies, neuromodulators, and other empirically validated approaches to achieve optimized treatment,” wrote researcher Richard B. Lipton, MD, from the Saul R. Korey Department of Neurology at Albert Einstein College of Medicine, and colleagues.

According to the study, achieving pain freedom at 2 hours and sustained pain response at 24 hours are important outcomes of any acute migraine therapy. Lipton and colleagues wanted to assess what percentage of patients with episodic migraine achieved these outcomes and what predictors could identify acute treatment response over multiple attacks.

The researchers surveyed 8233 respondents who met criteria for episodic migraine and reported the use of acute treatment for migraine. Respondents completed the 2006 American Migraine Prevalence and Prevention Study survey, answering questions on acute treatment outcomes. One question focused on 2-hour pain free response and the other on pain relief at 2 hours and 24 hours. The researchers classified responses as adequate if they were achieved “half the time or more” and inadequate if they were achieved “never,” “rarely,” or “less than half the time.”

Survey responses showed that 56% of respondents had inadequate 2-hour pain-free response to their usual acute treatment and 53.7% reported inadequate 24-hour pain relief. Forty-four percent of respondents achieved 2-hour pain relief; however, among those respondents, 25.7% reported recurrence of pain or inadequate 24-hour pain relief. According to the researchers this “highlights the importance of initial response to treatment in overall patient outcomes.”

The researchers were able to identify several significant predictors of inadequate 2-hour pain-free response including male sex, being unmarried, higher body mass index, higher headache pain intensity, cutaneous allodynia, more headache days per month, depression, and not using preventive migraine medications.

“High BMI has been associated with severe and progressive forms of migraine in previous studies and may reflect a proinflammatory state in obesity that renders treatment less effective,” the researchers wrote. “Inadequate 2-hour pain-free rates have been demonstrated in obese participants compared with normal-weight subjects for triptans.”

Respondents with inadequate 24-hour pain relief were more likely to have more headache days per month, which “may reflect the fact that more frequent attacks may be associated with prolonged activation of neuronal networks involved in pain processing during attacks, which may lead to lowering the threshold for subsequent attack.” In addition, inadequate 24-hour pain relief was associated with higher migraine symptom severity composite score, cutaneous allodynia, depression, and medication overuse.

According to the researchers, they “found that adequate response was the exception, not the rule, for several outcome measures. … optimized acute treatment may enhance self-efficacy, promote an internal locus of control, and reduce the risk of depression, which we found to be associated with poor response in the current study.”

Lipton RB, et al. Predicting inadequate response to acute migraine medication: results from the American Migraine Prevalence and Prevention (AMPP) Study. Headache. Epub 2016 Oct 12.