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Patientís Preference for Migraine Preventive Therapy
Peres MFP, Silberstein S, et al.
Posted: July 2007  
Headache 2007;47:540-545


Objective:   Preventive treatment is an important part of migraine therapy. When prescribing medication, physicians should understand patientsí treatment preferences and select drugs that most closely meet their patientsí needs. Understanding the factors that influence patientsí preference increases physiciansí ability to select appropriate migraine therapy. However, unlike acute migraine treatment, patientsí preferences for migraine preventive treatment have never been studied.

Methods:   We enrolled 250 patients and had a primary headache diagnosis. Patientsí age, gender, body mass index, headache diagnosis, headache frequency, duration, and intensity, headache disability, and current preventive treatments were ascertained. Patients were asked to rate 7 aspects of headache prevention (efficacy, speed on onset, out-of-pocket expenses, adverse events, formulation of therapy, type of treatment, and frequency of dosing) in order of importance. Each patient also evaluated 12 different clinical scenarios, each one containing a simulation of 2 hypothetical headache preventive treatments, wherein patients could choose Product A, Product B, or neither. Patients were informed of each productís efficacy data, adverse event profile (weight gain, concentration difficulty, and/or fatigue), and dosing frequency (once every 3 months, once per day, or twice per day).

Results:   Mean history of headache was 20.93 years. Fifty patients had 45 or more headache days in the past 3 months. Patients were on various preventive treatments, including beta-blockers, calcium-channel blockers, antidepressants, antiepileptics, neurotoxins, vitamins/herbal therapies, and nonmedicinal therapy. Of the 7 aspects of migraine prevention that patients were asked to rate, 72% rated effectiveness the most important aspect. Twelve percent rated speed of onset most important, 6% rated absence of adverse events most important, 3% rated formulation of therapy most important, 3% rated out-of-pocket expenses most important, and 2% rated type of treatment (prescription/vitamin) most important. Non rated frequency of dosing as the most important factor. In the area of preventive treatment scenarios, patients were more likely to choose treatments with higher efficacy rates, fewer adverse events and less frequent dosing schedule. Patients indicated that they preferred the treatment options with higher efficacy rates even if side effects were present and a more frequent dosing schedule was necessary.

Conclusion:   Patientsí preference regarding migraine prevention is very important in headache management. Patients rated efficacy the most important aspect in preventive therapy and preferred treatment options with higher efficacy rates. Further studies are needed for a better understanding of patientsí preference for migraine prevention.