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Success, Failure, and Tachyphylaxis with Prophylactic
Medication in a Migraine Population:
A Retrospective Analysis of 1012 Patients
Posted July 2000

Objectives: (1) Determination of migraine prophylactic medication efficacy with assessment of variables potentially impacting efficacy. (2) Evaluation of subsequent loss of efficacy, or tachyphylaxis.

Methods: Single-center retrospective analysis of migraine (IHS 1.1 or 1.2) patients evaluated initially 1994-1998 and followed a minimum of 6 months. Response to migraine prophylaxis, variables potentially linked to response (age, sex, drug, headache type, number of prior trials), and tachyphylaxis were assessed.

Results: A total of 1281 migraine patients (IHS 1.1 or 1.2) were evaluated from 1994-1998 with 1012 (79%) followed for at least 6 months. Of these patients, 174 (17.2%) had migraine with aura, 535 (52.9%) migraine without aura, and 303 (29.9%) migraine coexistent with episodic tension-type headache. There were 819 (80.9%) females and 193 (19.1%) males, with a mean age of 38.2 years (range 16-67). Upon presentation 386 patients (38.1%) had not previously received migraine prophylactic therapy, 348 (34.4%) had failed 1-2 trials, 147 (14.6%) had failed 3-4 trials, and 131 (12.9%) had tried 5 or more drugs. The average patient had tried a mean of 1.92 (range 0-16) prophylactic drugs. Of the 1012 patients, 150 (14.8%) did not warrant migraine prevention; 468 (46.2%) responded to the first drug, 221 (21.8%) to the second, and 94 (9.3%) to the third. Of the remaining 79 (7.8%), only 7 responded to any subsequent trials. The average patient tried a mean of 1.55 preventive medications (range 0-10). Age and sex had little impact on efficacy, while headache type, drug, and number of prior prophylactic trials were correlated with success rates. Of 412 patients table on a prophylactic agent for over 12 months, 64.4 (15.5%) were felt to experience tachyphylaxis.

Conclusions: Prophylactic medications are efficacious for a majority of migraine patients. Headache type, drug, and number of prior trials impact efficacy. Tachyphylaxis affectgs a minority of patients.