Abstract
BackgroundAlthough the criteria for acute migraine treatment and prevention have been well described, there are still unmet needs, general underuse and low benefits of preventive drugs.The aim of the present study was to retrospectively observe the short-term effect of preventive treatment in a cohort of migraine patients attending a tertiary headache center, using data from electronic medical records.MethodsThis was an observational retrospective cohort study based on data collected in a tertiary headache center. Data were extracted from an electronic dataset collected from January 2009 to December 2019. The main selection criteria were as follows: age of 18–75 years; diagnosis of migraine without aura (MO), migraine with aura (MA) or chronic migraine (CM); a control visit 3 months after the first access; and prescription of preventive treatment with level of evidence 1 as reported by Italian guidelines. As the primary outcome, we considered the change in the frequency of headache at the follow-up visit. Then, as secondary outcome measures, we used disability scores, intensity of headache, and allodynia. As predictive factors, we considered age, migraine duration, sex, headache frequency, allodynia, anxiety and depression at baseline, and comorbidity with fibromyalgia.ResultsAmong the 6430 patients screened, 2800 met the selection criteria, 1800 returned to the follow-up visit, 550 withdrew because of adverse events, and 1100 were included the analysis. One hundred thirty-four patients had a frequency reduction of 50% or more. Flunarizine was used for less severe migraine, with a better effect compared to those of other drugs (odds ratio: 1.48; p: 0.022). Low headache frequency and absent or mild allodynia predicted a better outcome.ConclusionsThe mild effect of preventive drugs on migraine features and even the number of patients who were lost to follow-up or dropped out because of adverse events confirm that in severe and chronic patients, the first line of prevention can only delay a more focused therapeutic approach.
Highlights
The criteria for acute migraine treatment and prevention have been well described, there are still unmet needs, general underuse and low benefits of preventive drugs
The rate of improvement was estimated on the basis of the reduction in triptan use; the use of triptans was even significantly lower among subjects treated with oral preventive therapies than among those without these drugs, though mild improvement was present in the group with chronic migraine [3]
Among a total of 4480 migraine patients with highmedium headache frequency, 2800 met the selection criteria, while 550 were under current or had previously received preventive treatments; 320 were using CNStargeting drugs for psychiatric comorbidity; 540 reported other primary headaches in association with migraine such as tension-type headache or primary stabbing headache; 102 had other neurological diseases, such as multiple sclerosis, polyneuropathies, previous cerebrovascular disorders, dementia and myasthenia; and the remainder were affected by severe general medical diseases (Fig. 1)
Summary
The criteria for acute migraine treatment and prevention have been well described, there are still unmet needs, general underuse and low benefits of preventive drugs. Despite the criteria of acute episodes, treatment and prevention having been well described [2], there is still a large proportion of patients with unmet needs, general underuse and low benefits of preventive treatments [3]. The French SMILE study assessed the determinants of the prescription of migraine preventive therapy by GPs and neurologists and factors determining eligibility, such as the frequency and severity of headache and scarce evidence of the efficacy of acute treatment [5]. The study underlined that the current use of preventive therapies is limited and has negligible benefits and that most migraine patients currently have unmet needs
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