To assess the gaps in acute treatment optimization in participants with migraine from the CaMEO-I study.

In migraine, inadequate management of migraine attacks is a risk factor for disease progression. Despite the numerous currently approved acute treatments for migraine, many patients experience suboptimal acute management. 

CaMEO-I, a longitudinal, web-based survey with cross-sectional modules conducted in 2021-2022 across six countries, identified adult respondents who met modified ICHD-3 criteria for migraine. This data analysis focused on the US responders across three areas relevant to acute treatment optimization: 1. Acute medication Overuse (ICHD-3 criteria); 2. Acute treatment discontinuation (Past medication use for migraine and reasons for non-persistence); 3. Acute treatment tolerability concessions (Perceptions of efficacy and tolerability). The Migraine Treatment Optimization Questionnaire (mTOQ-4) assessed treatment efficacy and defined response categories based on total scores: very poor, poor, moderate, and maximum.

Of 2404 US respondents with migraine, 2226 reported using acute medication(s), 25.2% (561) met criteria for medication overuse (single-class or multiclass) and of 561 medication overusers, 66.1% (371) scored very poor to poor on treatment optimization. Among the 2404 respondents, 27.2% (653) had stopped using ≥1triptan, and 11.2% (270) respondents discontinued triptans entirely. The most commonly cited reason for discontinuing triptans among these 270 respondents was lack of efficacy, 37.0% (100). Among current triptan users 390 respondents received triptan related efficacy and tolerability questions, 39.3% (153) reported experiencing side effects and/or issues with tolerability; 60.5% (236) reported pain freedom within 2 hours of triptan use half the time or less, or never/rarely. Of 585 total current triptan users, 59.7% (349) scored very poor to poor on acute treatment optimization.

In a representative US sample of people with migraine who received triptans, 11.2% discontinued them. Among those who remain on triptans, treatment optimization is generally poor, due to lack of efficacy and poor tolerability.