Abstract
BackgroundReal-world data on sufficient/insufficient response, and predictors of insufficient response, to acute treatments for migraine are limited in Japan. This study aimed to identify factors associated with insufficient response to acute treatment of migraine by exploring significant differences between people with migraine who sufficiently/insufficiently respond to prescribed acute treatment in Japan.MethodsThis was a retrospective analysis of 2014 Adelphi Migraine Disease Specific Programme cross-sectional survey data collected from physicians and their consulting adult patients with migraine in Japan. Insufficient responders to prescribed acute treatment were patients who achieved headache pain freedom within 2 h of acute treatment in no more than three of their last five migraine attacks. Factors associated with insufficient response to prescribed acute migraine treatment were identified using backward logistic regression.ResultsOverall, 227/538 (42.2%) patients were classified as insufficient responders to prescribed acute migraine treatment. Significantly more insufficient responders than sufficient responders had consulted a neurologist or a migraine/headache specialist, and had chronic migraine or medication-overuse or tension-type headaches (p < 0.05). More insufficient responders than sufficient responders reported taking acute treatment when/after the pain started (77.0 vs. 68.9%) than at first sign of migraine (p < 0.05). Compared with sufficient responders, insufficient responders reported a significantly higher mean ± standard deviation (SD) Migraine Disability Assessment total score (12.7 ± 23.3 vs. 5.8 ± 10.4, p < 0.001) and lower quality of life (EuroQol-5 Dimensions utility score 0.847 ± 0.19 vs. 0.883 ± 0.16, p = 0.024). Factors significantly associated with insufficient response to acute treatment included seeing a neurologist versus an internist (odds ratio [OR] 1.93; 95% confidence interval [CI] 1.29–2.88; p = 0.002), taking acute medication when/after pain started versus at first sign of migraine (OR 1.65; 95% CI 1.05–2.60; p = 0.030), a higher MIDAS total score (OR 1.04; 95% CI 1.02–1.06; p < 0.001), and presence of comorbid cardiovascular disease (OR 0.53; 95% CI 0.28–0.98; p = 0.044).ConclusionsMany people with migraine in Japan struggle to adequately treat migraine attacks with prescribed acute medication and exhibit high levels of unmet need for acute treatment. Optimized management strategies utilizing existing therapeutic options as well as additional effective therapeutic options for migraine are required to improve symptoms and quality of life.
Highlights
Real-world data on sufficient/insufficient response, and predictors of insufficient response, to acute treatments for migraine are limited in Japan
Factors significantly associated with insufficient response to acute treatment included seeing a neurologist versus an internist, taking acute medication when/after pain started versus at first sign of migraine, a higher Migraine disability assessment (MIDAS) total score, and presence of comorbid cardiovascular disease
Many people with migraine in Japan struggle to adequately treat migraine attacks with prescribed acute medication and exhibit high levels of unmet need for acute treatment
Summary
Real-world data on sufficient/insufficient response, and predictors of insufficient response, to acute treatments for migraine are limited in Japan. According to current International Headache Society (IHS) guidelines, the 2-h pain-free response provides the most clinically relevant information about the efficacy of an acute treatment for migraine [3]. In a US longitudinal population-based study (American Migraine Prevalence and Prevention [AMPP]), > 40% of people with episodic migraine were found to have at least one unmet need with their current acute treatment, which included the domain satisfaction with therapy (assessed as lack of efficacy, tolerance, or overall satisfaction with the medication) [5]. 56% of individuals with episodic migraine reported an insufficient treatment response to acute medication (insufficient 2-h pain-free response) [6]. It should be noted that individuals with episodic migraine who do not respond to acute treatments are at risk of progressing to chronic migraine [7]
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