Patient Reluctance as a Possible Barrier to Taking Migraine Preventive Medications: Results of the OVERCOME (US) Study
Jessica Ailani1, Eva Muenzel2, Elizabeth Johnston2, Helen Hochstetler2, Betzaida Martinez2, Rose Okonkwo2, Robert Nicholson2, Bert Vargas2, Richard Lipton3
1Medstar Georgetown Neurology, 2Eli Lilly & Company, 3Albert Einstein College of Medicine; Montefiore Medical Center
Objective:
To determine the reasons for non-adoption of migraine preventive medications.
Background:
Despite being eligible for preventive migraine treatment, many people with migraine have never taken preventive medications for various reasons.
Design/Methods:
A representative sample of US adults with migraine was identified from the web-based OVERCOME (US) study, via a self-reported, validated diagnostic questionnaire using the International Classification of Headache Disorders, 3rd edition criteria. Based on the American Headache Society 2021 consensus statement1, people with ≥6 monthly headache days (MHDs), 4-5 MHDs with Migraine Disability Assessment (MIDAS) ≥11 (moderate disability), or 3 MHDs with MIDAS ≥21 (severe disability), were considered eligible to receive migraine preventive treatment. People who never received a preventive medication for migraine were asked to select all that apply from a list of 16 reasons why they had “never taken a prescription medication to prevent or reduce the frequency, severity, or duration” of their migraine or severe headaches.
Results:
Among 59,001 people with migraine identified in OVERCOME (US), 37.7% (n=22,249) were eligible for migraine preventive treatment. Despite eligibility, 65.3% (n=14,534) had never taken a preventive medication for migraine; their mean age was 40.3 years, they had migraine for a mean of 18.4 years, 79.4% were female, and 82.2% were Caucasian. Half (49.9%) of this group selected only one reason for never having taken migraine prevention, 21.4% selected two, and 28.7% selected ≥3 reasons. The top three reasons selected were (a) ‘I am concerned about side effects of medications/the effects of using them too often’ (25.5%), (b) ‘I do not like taking prescription medications’ (23.3%), and (c) ‘The other medications I use work well enough’ (20.8%).
Conclusions:
Despite meeting the eligibility criteria for preventive migraine treatment, a majority of these people had never taken migraine preventive medication. Understanding the reasons may help clinicians address the concerns of these patients.
1Ailani et al 2021;61(7):1021-1039.