Preventive treatment patterns and treatment satisfaction in migraine: results of the OVERCOME (EU) study

Abstract

Background Insights into the burden, needs and treatment of migraine from internet-based surveys in diverse real-world migraine populations are needed, especially at a time when novel preventive migraine medications are becoming part of the therapeutic armamentarium. The objectives of this analysis are to describe traditional preventive (orals and onabotulinum toxin A) treatment patterns in the OVERCOME (EU) study migraine cohort, as well as treatment patterns and patient satisfaction with current treatment in a subgroup of respondents eligible for migraine preventive medication. Methods The cross-sectional non-interventional OVERCOME (EU) study was conducted (October 2020–February 2021) via an online survey among adults (aged ≥ 18 years) resident in Germany or Spain. Participants, registered in existing online panels, who were willing to provide consent were considered. The migraine cohort included participants reporting headache/migraine in the past year, identified based on a validated migraine diagnostic questionnaire and/or self-reported physician diagnosis. A subgroup of survey respondents defined as eligible for migraine preventive medication at the point in time the cross-sectional survey was taken was also analysed. Variables assessed included sociodemographic and migraine-related clinical characteristics, preventive (traditional and calcitonin gene-related peptide monoclonal antibodies) treatment patterns and patient satisfaction with current treatment. Results are descriptive only. Results Of the 20,756 participants in the migraine cohort, 78.5% sought professional medical care, 50.8% received a migraine diagnosis and only 17.7% had ever used preventive medication. Half (53.3%) of participants currently using preventives took their most recent medication for six months or less. Most patients (73.9%) classified as eligible for preventive medication (based on headache frequency and/or at least moderate disability due to migraine) reported not using traditional preventives and many of those who did (66.8%) were not satisfied with their current standard of care. Conclusions Our findings highlight the low proportion of people diagnosed with migraine despite a higher rate of consultation and suggest the need for better access to treatment for people with migraine and new preventive therapies with improved efficacy and safety profiles to improve adherence and patient satisfaction.

Acute Treatment Patterns, Migraine Burden, and Healthcare Resource Use in People With Migraine: Results From the OVERCOME (EU) Observational Study

“…OVERCOME (EU) was an online, non-interventional, cross-sectional, observational survey conducted in adults (aged ≥ 18 years) in Spain and Germany between October 2020 and February 2021. Full details of the study design and methods, including the survey instrument used, are published elsewhere [ 23 ]. Briefly, participants registered in existing opt-in online survey panels [Kantar Profiles (Lightspeed) global panel and its partners] [ 24 ] were invited to participate in a health survey without knowledge of the specific health topic.…”

“…Here, we report the data on the burden of migraine/severe headache and the use of acute medication and healthcare resources in Spain and Germany. The use of preventive medication by participants in this study is reported elsewhere [ 23 ]. We also report findings of a subcohort analysis of participants with moderate to severe headache attacks to determine the burden in this population, and whether these people are using triptans in line with Spanish and German guidelines [ 17 , 18 ].…”

Medication “underuse” headache

“…Note that these studies were conducted in a headache center, where the doctors are more likely to use optimal treatment. A large cohort study (the ObserVational survey of the Epidemiology, tReatment and Care Of MigrainE (Europe) (OVERCOME [EU]), found that 73.9% of the patients who were eligible for the use of preventive medication were not using it (65). The prospective cohort Assessment of Tolerability and Effectiveness in Migraine Patients using Preventive Treatment (ATTAIN) study, found that prior to the introduction of anti-calcitonin gene-related peptide (CGRP) preventive therapy, despite high burden and frequent headache days, 70.1% of patients had been treatment naı¨ve (66).…”

“…The Second International Burden of Migraine Study (IBMS-II) found that lack of efficacy was the reason for discontinuation in 36.8-47.6% in EM patients and 39.2-48.2% in CM patients, whereas side effects were found to be the issue in 34.8-49.0% of EM patients and in 34.2-53.2% of CM patients, respectively (71). The OVERCOME [EU] study found that 66.8% of the patients were dissatisfied with their current treatment (65). In addition, the ATTAIN study showed that side effects was the most common reason for dissatisfaction, followed by lack of efficacy (66).…”

“…The OVERCOME [EU] study found that only 33.2% of those who were using preventive medication were satisfied with it. Although the study did not mention the reason behind the satisfaction or lack of it, it provides a wider picture of the unmet need in migraine prevention (65). In a discrete choice experiment, 300 participants were invited to participate in a survey.…”