Discontinuation of Acute Prescription Medication for Migraine: Results From the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study

Abstract

Objective: This analysis assessed migraine-related burden and treatment decisions in Chronic Migraine Epidemiology and Outcomes (CaMEO) Study survey respondents who stopped taking acute prescription medications for migraine.

Background: Migraine is a common yet underdiagnosed and undertreated neurological disease often associated with significant disability. Acute prescription medications are underused, in part because patients discontinue treatment. Rates and reasons for discontinuing acute prescription medications require exploration.

Methods: The CaMEO Study is a longitudinal, Internet-based survey that identified and followed people who met modified ICHD-3 migraine criteria. For this analysis, eligible respondents had used acute prescription medication for migraine in the past but no longer used or kept these treatments on hand (discontinued users). Respondents who reported discontinuing acute prescription treatment answered questions about length of time since last use and reasons for stopping. Reasons for discontinuing were thematically summarized. Monthly headache day frequency, Migraine Disability Assessment (MIDAS), Patient Health Questionnaire 9-item depression screener, Generalized Anxiety Disorder 7-item screener, and the 12-item Allodynia Symptom Checklist were also assessed.

Results: Of 13,624 respondents with migraine, 4840 (35.5%) had ever used acute prescription medications and 1719 (35.5%) of those were discontinued users. Discontinued users had a mean (SD) age of 42.1 (14) years, and 1348/1719 (78.4%) were female. Monthly headache frequency of 0-4 days was reported by 1073/1719 (62.4%) of respondents, 5-9 days by 322/1719 (18.7%), 10-14 days by 135/1719 (7.9%), and ≥15 days by 189/1719 (11.0%). Two-thirds (1160/1719 [67.5%]) of discontinued users reported a receiving migraine (or chronic migraine) diagnosis from a doctor or other health professional in the past. Although all had spoken to a doctor about their headaches, 1504/1719 (87.5%) had stopped having their headaches managed or treated by a doctor for at least 12 months. Only 1 in 5 discontinued users reported being able to work or function normally with a headache, and 717/1719 (41.7%) had moderate to severe disability (MIDAS). Among the most commonly reported reasons for prescription medication discontinuation were switching to non-prescription pain medication (782/1719 [45.5%]), as well as concerns about prescription medication efficacy (484/1719 [28.2%]) and tolerability (428/1719 [24.9%]). Nearly half of respondents who reported either efficacy or tolerability concerns had moderate to severe disability.

Conclusions: People with migraine who discontinue acute prescription medication have a high level of unmet treatment need. The majority cannot work or function normally with headaches, with 646/1719 (37.6%) of discontinued users reporting 5 or more headache days per month.

Keywords: Chronic Migraine Epidemiology and Outcomes; acute treatment; disability; migraine; triptans.

Figure 1

Severity of disability, depression, and anxiety in respondents who discontinued acute prescription medication for migraine.^{a a}Severity levels as determined by the individual scales. GAD‐7 = Generalized Anxiety Disorder 7‐item screener; MIDAS = Migraine Disability Assessment; PHQ‐9 = Patient Health Questionnaire 9‐item depression screener.

Figure 2

Migraine‐related disability^a among users who discontinued medication use by domains associated with discontinuation. ^aAs determined by the Migraine Disability Assessment (MIDAS), where score 0‐5 = grade I (little or no disability), 6‐10 = grade II (mild disability), 11‐20 = grade III (moderate disability), ≥21 = grade IV (severe disability).

Figure 3

Migraine‐related disability^a among respondents endorsing efficacy and/or safety domains. ^aAs determined using the Migraine Disability Assessment (MIDAS), where score 0‐5 = grade I (little or no disability), 6‐10 = grade II (mild disability), 11‐20 = grade III (moderate disability), and ≥21 = grade IV (severe disability).