What do patients’ efficacy and tolerability ratings of acute migraine medication tell us? Cross-sectional data from the DMKG Headache Registry

Abstract

Background Most migraine patients need an effective acute medication. Real-world data can provide important information on the performance of acute migraine medication in clinical practice. Methods We used data from the German Migraine and Headache Society Headache Registry, where patients rate efficacy and tolerability of and satisfaction with each of their acute headache medications. Results A total of 1756 adult migraine patients (females: 85%, age: 39.5 ± 12.8 years, headache days per month: 13.5 ± 8.1) were included. Of these, 93% used acute medication, most frequently triptans (59.3%) and/or non-opioid analgesics (56.4%), and 58.5% rated efficacy as good or very good. This was more frequent for triptans (75.4%) than for non-opioid analgesics (43.6%, p < 0.001). Among non-opioid analgesics, naproxen was rated most effective (61.9% very good or good, p < 0.001 compared to ibuprofen, acetylsalicylic acid and paracetamol). Patient-rated efficacy significantly declined with higher headache frequencies (p < 0.001), and this effect remained significant after omitting patients overusing acute medication. Conclusion In the present population recruited at specialized headache centers, patients rated triptans as more effective than non-opioid analgesics, naproxen as more effective than ibuprofen, and acute medication efficacy decreased with increasing headache frequency. Trial registration: The German Migraine and Headache Society Headache Registry is registered with the German Clinical Trials Register (DRKS 00021081).

Triptan non-response in specialized headache care: cross-sectional data from the DMKG Headache Registry

“…Also, there is no way to know if patients observed the rules of early dosing and treating several attacks before declaring failure of a specific triptan. Regarding dosages, our previous results show that triptan underdosing is very rare in the present sample [ 16 ]. Nonetheless, choice of a low vs. high dose within the range of recommended dosages might affect triptan efficacy and tolerability.…”

“…Previous studies have reported that triptan non-responders have more severe migraine (higher frequency and intensity, more accompanying symptoms, higher disability) than triptan responders [ 1 , 15 ], and a previous DMKG Registry analysis showed that migraine patients with higher headache frequency have lower acute medication efficacy [ 16 ]. The present data expand these results, showing that migraine severity (headache and severe headache frequency, a chronic migraine diagnosis, headache intensity) and associated disability (MIDAS) further increased with increasing level of triptan failure (Fig.…”

Monoclonal antibodies targeting the calcitonin gene-related peptide pathway improve the effectiveness of acute medication—a real-world study

“…One of the fundamental goals of migraine prevention is to improve the response to acute treatment. The assessment of patient satisfaction with acute treatment is of particular importance in clinical practice because of its strong association with migraine-related disability [ 18 – 20 ]. However, this objective remains underexplored, even in the context of randomized controlled trials and real-world studies examining CGRP-mAbs, which focused more on acute medication intake than on their effectiveness [ 3 , 4 , 21 , 22 ].…”

Migräne und psychosomatische Komorbiditäten

“…Typische Prädiktoren für eine schlechtere Response auf CGRP-Antikörper sind das Vorliegen einer chronischen Migräne, eines Medikamentenübergebrauchs und einer Depression [17]. Auch die Migräne-Akuttherapie mit Triptanen oder Nicht-Opioid-Analgetika ist bei häufigeren Kopfschmerzen signifikant weniger wirksam [18].…”