Characterizing Preventive Treatment Gaps in Migraine: Results from the CaMEO Study
Stephanie J. Nahas1, Dawn C. Buse2, Susan Hutchinson3, Michael L. Reed4, Kristina M. Fanning4, Brett Dabruzzo 5, Richard B. Lipton2
1Thomas Jefferson University, 2Albert Einstein College of Medicine, 3Orange County Migraine and Headache Center, 4Vedanta Research, 5AbbVie
Objective:
Characterize self-reported use of preventive medication for migraine and treatment gaps in a representative US sample. 
Background:
Current preventive treatments for migraine are underused and may fail to meet treatment goals.
Design/Methods:
CaMEO, a web-based survey conducted September 2012 to November 2013, identified and characterized people who met modified International Classification of Headache Disorders, 3rd edition criteria for migraine. Respondents were categorized by oral preventive medication use status, and prespecified treatment gaps were characterized.
Results:
Of 16,789 CaMEO respondents who met criteria for migraine, 39% (n=6579) reported ≥4 monthly headache days (MHDs) and were included in this sample of potentially preventive-eligible respondents. Within this group, 80.2% (5275/6579) reported never using, 9.8% (642/6579) reported currently using, and 10.1% (662/6579) reported previous but not current use of a daily oral migraine preventive. Among never users with ≥4 MHDs, 61.8% (3259/5275) were interested in trying a daily oral prescription preventive; 40.9% (2159/5275) were interested in trying an injectable preventive medication. Among current users, 85.7% (550/642) reported they were somewhat/very interested in trying an oral, daily preventive medication and 63.6% (408/642) were interested in trying an injectable preventive. Among discontinued prevention users with ≥4 MHDs, factors contributing to discontinuation included concerns regarding safety and tolerability in 44.6% (295/662) and insufficient efficacy in 34.8% (263/662).
Conclusions:
Among people with migraine potentially eligible for prevention, <10% were currently using a migraine preventive and an additional 10% had discontinued prevention. Discontinuations were attributed to concerns about safety and tolerability, and lack of efficacy. Although the majority (80%) of those with ≥4 MHDs had never used a preventive, most were interested in trying prevention, with greater interest in oral vs injectable options. Treatment gaps in current and discontinued users suggest additional treatment options are needed with improved efficacy and tolerability profiles.