Failure of Preventive Treatments in Migraine: An Observational Retrospective Study in a Tertiary Headache Center

Abstract

BACKGROUND Despite the criteria of acute migraine treatment and prevention have been well described , there are still unmet needs, for a general underuse and low benefit of preventive treatments. The aim of the present study was to observe retrospectively the short term effect of preventive treatment in a cohort of migraine patients come at a tertiary headache center, using data from an electronic medical record. METHODS This was an observational retrospective cohort study on data collected in a tertiary headache center. Data were extracted from an electronic dataset collected between January 2009 to December 2019. Main selection criteria were age 18-75, diagnosis of migraine without aura(MO), with aura (MA) and chronic migraine (CM), a control visit after three months from the first access, prescription of preventive treatment with level of evidence 1 as reported by Italian guidelines. As primary outcome measure we considered the change of frequency of headache at follow up , as second outcomes disability scores , intensity of headache, allodynia; as predictive factors age, migraine duration, sex and headache frequency, allodynia, anxiety and depression at baseline; comorbidity with fibromyalgia. RESULTS Among 6430 patients screened,2800 met the selection, 1800 returned to follow up, 550 withdrawn for adverse events, 1100 were introduced into analysis. One hundred thirty four had a frequency reduction of 50% or more. Flunarizine was used in less severe migraine, with a better effect as compared to other drugs (odds ratio 1.48; p 0.022). Low headache frequency and absent or mild allodynia predicted a better outcome. CONCLUSIONSThe mild effect of preventive drugs on migraine features and the number of patients lost to follow up or dropped out for adverse events confirm that in severely and chronic sufferers the first line preventive approach could delay a more focused therapeutic approach.

Time course of efficacy of atogepant for the preventive treatment of migraine: Results from the randomized, double-blind ADVANCE trial

“…In studies that evaluated individual preferences for the treatment of migraine, participants ranked efficacy, speed of onset, and an oral formulation among the most important attributes when choosing a preventive medication (8)(9)(10). However, some current oral preventive drugs require administration for several weeks or months before therapeutic benefit occurs, with many individuals still failing to achieve sufficient efficacy (11,12). When efficacy is not reached after a certain treatment duration, or a medication has been titrated to the ceiling dose but is no longer effective or tolerated, it is recommended to re-evaluate and possibly discontinue treatment (4,5).…”

Real-world migraine-related healthcare resource utilization and costs associated with improved vs. worsened/stable migraine: a panel-based chart review in France, Germany, Italy, and Spain

“…Taken together, these findings provide valuable information on the economic burden associated with migraine chronification A c c e p t e d M a n u s c r i p t in Europe. Considering the impact of migraine chronification, effective preventive therapies that can prevent chronification are needed to reduce the resource and cost burden among patients with migraine in real-world practice [17,29,30].…”

“…Several preventive medications (anticonvulsants, antihypertensives, antidepressants, serotonin antagonists, calcium channel antagonists, onabotulinumtoxin A [for CM], and calcitonin gene-related peptide [CGRP] monoclonal antibodies) have been used in clinical practice for treating migraine [15,16]. Unfortunately, many of the available preventive therapies have failed to impart the desired improvement, leading to increased resource use and cost burden on the healthcare system [17].…”