What Do Patients With Migraine Want From Acute Migraine Treatment?

Abstract

Migraine is a common chronic condition with an ever-expanding therapeutic armamentarium. As therapeutic options multiply, it is increasingly important to understand patients' attitudes and preferences regarding various treatment characteristics. Several strategies have evolved to establish treatment priorities in migraine and rationalize and prioritize end points and outcomes to meet the needs of patients. A survey of a population-based sample of migraineurs indicated that an overwhelming majority of patients consider complete relief of head pain, no recurrence, and rapid onset of action as important or very important attributes of acute migraine therapy. An analysis of the relationship between clinical end points and satisfaction found that more than 90% of patients who were pain-free at 2 hours were at least somewhat satisfied with treatment, but satisfaction was dependent on relatively rapid relief. Using a "willingness-to-pay" approach, results indicated that while patients will pay more for migraine treatment that produces rapid, consistent relief without adverse effects or recurrence, speed of complete relief is the most valued attribute. By assessing physician preferences and practices, degree of pain relief and rapid onset were identified as the most important attributes of acute therapy. Based on results from preference studies of triptans, 50% of patients cited more rapid pain relief as the most important determinant of treatment preference. Based on these various approaches, the consensus view is that both clinicians and patients desire a broad range of positive migraine treatment attributes, but rapid onset of complete pain relief is a particularly important priority.

Treatment satisfaction with zolmitriptan nasal spray for migraine in a real life setting: results from phase two of the REALIZE study

“…In the present study, the majority of patients (about 76%) were "very satisfied" or "satisfied" with zolmitriptan nasal spray with regard to speed of relief and reliability. Such attributes have been previously identified as being important characteristics of an acute migraine therapy [16][17][18]. Furthermore, the majority of patients would be willing to use zolmitriptan nasal spray in the future and preferred zolmitriptan nasal spray over previous therapies.…”

The broad treatment expectations of migraine patients

“…Migraineurs' expectations have been well studied and defined, but only for the acute attack [9][10][11][12][13][14]. Overall treatment expectations have not been addressed.…”

Value of postmarketing surveillance studies in achieving a complete picture of antimigraine agents: using almotriptan as an example

“…The Spanish and German studies assessed efficacy using the conventional acute migraine therapy endpoint 2-h PR along with 2-h PF and SPF. The 2-h PF and SPF endpoints are highly relevant to migraineurs because they incorporate top-ranked treatment attributes: rapid response, and complete freedom from pain in 2-h PF, and rapid response, complete freedom from pain, and no headache recurrence in SPF [15].…”

“…Third, this endpoint does not reflect patients' therapeutic goals. Survey data indicate that most migraineurs want acute therapies to provide complete freedom from pain [15,16]. Finally, the discriminatory power of the 2-h PR endpoint is poor, as shown by the lack of difference in 2-h PR rates between triptans and analgesics in many RCTs [17].…”