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%).Conclusion: The effect of CM prophylaxis was related to the frequency of headache. Only 34.5% of the patients continued to take medicine after 12 weeks of treatment, suggesting that patient compliance needs to be enhanced in the prophylaxis of CM. For the Chinese headache society, the best way to increase patient compliance should be treatment at dedicated headache centers and timely visits to headache specialists.
Highlights
Chronic migraine (CM) is a common disabling disease with a global prevalence of ∼1–2% [1, 2]
The efficacy of the medication for the patient was evaluated after 4 weeks of prophylactic treatment; the medication was effective for 431 patients (61.7%) and ineffective for 267 patients (38.3%)
Metoprolol was effective for 51 patients (78.5%); flunarizine was effective for 233 patients (66.4%); amitriptyline was effective for 57 patients (34.1%); topiramate was effective for 47 patients (75.8%); metoprolol and flunarizine, used in combination, were effective for 43 patients (81.1%)
Summary
Chronic migraine (CM) is a common disabling disease with a global prevalence of ∼1–2% [1, 2]. The disease seriously affects the quality of life of patients and wastes numerous social resources [3]. CM treatment is still mostly a drug-based treatment, including acute treatment [4] and preventive treatment. Patients often respond poorly to preventive treatment [5,6,7] and have a low compliance with long-term medications [8]. The purpose of this study was to determine the factors that affect the efficacy of first-time treatment in patients with CM and to assess patient compliance with oral prophylactics
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