Medication overuse occurs in nearly 75% of patients with chronic migraine who are correctly diagnosed and receive minimally appropriate acute and preventive pharmacologic treatment, said Professor Dawn Buse, Albert Einstein College of Medicine, NY, at AAN 2021. It results from suboptimal use of acute and preventive therapies and can be prevented by consultation with a medical professional experienced in managing migraine, an accurate diagnosis, and appropriate guideline-based treatment.
The barriers to good medical outcomes for migraine
Suboptimal use of acute and preventive therapies leads to medication overuse
Patients with migraine achieve a good medical outcome when their healthcare journey traverses four barriers, said Professor Buse. Listed in the order in which they feature in a patient’s healthcare journey, these barriers are:
- Consultation with a medical professional experienced in managing migraine
- Accurate diagnosis
- An individualized treatment plan that includes appropriate guideline-based acute and preventive treatment1
- Avoidance of suboptimal use of acute and preventive therapies leading to medication overuse2,3
Failure to traverse these barriers is associated with:
- An increased risk of migraine progression4,5
- Headache-related disability2,6
- Psychological symptoms4
What proportion of patients with migraine avoid medication overuse?
74.7% of respondents with CM who were correctly diagnosed and received minimally appropriate acute and preventive pharmacologic treatment met acute medication overuse criteria
Professor Buse presented the results of a survey of 16,789 individuals with migraine that evaluated the proportion of people traversing each of the four barriers to achieve a good medical outcome.7
Of the 9184 respondents to the US Internet-based Chronic Migraine Epidemiology and Outcomes (CaMEO) study who met the eligibility criteria:
- 1254 had chronic migraine (CM)
- 7930 had episodic migraine (EM)
Only 1.8% of respondents with CM traversed all four barriers
Among respondents with CM, only 1.8% of traversed all four barriers:
- 40.8% reported current headache consultation
- 32.8% of consulters received an accurate diagnosis
- 54.2% of those with an accurate diagnosis received minimally appropriate acute and preventive pharmacologic treatment
- 74.7% of diagnosed and treated consulters met acute medication overuse criteria
Blacks and/or African Americans and multiracial respondents had a higher rate of acute medication overuse
Among respondents with EM, only 8.5% of traversed all four barriers:
- 27.6% reported current headache consultation
- 75.7% of consulters received an accurate diagnosis
- 59.9% of those with an accurate diagnosis received minimally appropriate acute and preventive pharmacologic treatment
- 31.8% of diagnosed and treated consulters met acute medication overuse criteria
A higher income was significantly associated with an increased rate of traversing each barrier.
Blacks and/or African Americans had higher rates of consultation than other racial groups and higher rates of acute medication overuse. Multiracial respondents also had a higher rate of acute medication overuse.
