Factors Affecting Preventive Treatment Outcomes for Patients With Newly Diagnosed Chronic Migraine and Their Compliance With Treatment Recommendations in Chongqing Province, China: An Open-Label Prospective Study With Retrospective Baseline

Abstract

Objective: This study aims to investigate the factors affecting the efficacy of first oral prophylaxis in patients with chronic migraine (CM) and to assess patient compliance with their medication regimens.Method: To identify the therapeutic effect of prevention medication in 740 patients with newly diagnosed CM that did not receive any preventive treatments after 4 weeks in an open-label prospective study with retrospective baseline from January 2016 to January 2018, the factors that may affect the outcomes of preventive treatment were analyzed based on the demographic characteristics, migraine characteristics, family history of headache, and history of medication overuse. Moreover, the patients were followed up to evaluate their compliance with and the side effects of the medication at 4 weeks and at 12 weeks.Results: After 4 weeks of prophylaxis, 94.3% (n = 698) of the patients persisted with taking the medicine. The treatment was effective for 61.7% of CM patients (n = 431) and ineffective for 38.3% (n = 267). The results showed that the effectiveness of the preventive treatment was related to the number of headaches per month, and the effect was better for patients with headaches for 15-20 days/month than for those with headaches for 26-30 days/month (OR = 2.78, 95% CI: 1.26-5.75, P = 0.006). After 12 weeks of treatment, only 34.5% (n = 255) of the patients persisted with taking the medicine. The most common reason for non-compliance in CM patients is appointment difficulty in a headache clinic (31.8%).

Migraine Treatment: Towards New Pharmacological Targets

“…Furthermore, even when repositioning drugs is well tolerated, a significant percentage of patients may not adequately respond (or not respond at all). Therefore, preventive treatments switches become necessary, finally resulting in a "trial and error process", experienced as frustrating for both physicians and patients and leading to the well-known low adherence to therapeutic strategies (approximately 30%) observed in the migraine patients population [4,12].…”

“…The hallmark of migraine treatment is represented by approaches aimed to prevent future attacks based on lifestyle modifications, to avoid identified triggers or predisposing factors, as well as on preventive medications, and to reduce the frequency and severity of migraine attacks [3]. Until five years ago, preventive migraine treatments were based on 'repositioning drugs,' molecules with different and pleiotropic targets, developed for other indications and discovered by serendipity to be rather effective in migraine prevention (i.e., β-blockers, antiepileptics drugs, antidepressants, and calcium channel antagonists), although burdened by tolerability issues leading to low treatment adherence [4]. However, the significant progresses in unravelling the pathophysiology of migraine attacks allowed the identification of putative specific targets for preventive migraine treatments, such as the calcitonin gene-related peptide (CGRP) pathway [5,6].…”

Placebo and nocebo in the treatment of migraine: How much does real world effectiveness depend on contextual effects?

“…Nevertheless, there is a need for further research comparing the effectiveness of option listing versus recommending in migraine treatment prescriptions. The importance of communication between a migraine patient and a doctor is also demonstrated by the fact that the most common reason for non-compliance in chronic migraine patients is appointment availability in a specialized headache clinic (104). All of these aspects need to be taken into account by the headache physician whenever a new treatment for migraine is planned or attempted.…”

Telemedicine efficacy and satisfaction of patients and headache specialists in migraine management

“…At the same time, only 13.8% of Chinese migraine patients have correctly diagnosed ( Liu et al, 2013 ), nearly half of whom do not use pain medication correctly, and only 2.7% of patients use migraine preventive medication in any case ( Li et al, 2012 ). Even if migraine patients attend a headache specialist clinic, the compliance rate for chronic migraine may be only 34.5% ( Yuan et al, 2020 ). Since the outbreak of COVID-19, strict transportation restrictions and quarantine policies in China have made cross-regional visits more difficult, and remote migraine patients’ access to care and follow-up is further limited.…”