Objective:

Evaluate the relationship between the number of traditional oral generic preventive medications (OGPMs) and patient-reported outcomes (PROs) in US respondents of the Chronic Migraine Epidemiology and Outcomes–International (CaMEO-I) study.

Background:

Design/Methods:

CaMEO-I was a cross-sectional, web-based survey conducted in 2021-2022 in six countries. Respondents with ICHD-3 migraine were stratified by self-reported history of ever using 1, 2, or ≥3 OGPMs; those who had used branded preventive medication(s) were excluded. Associations between OGPM use and migraine-related disability (Migraine Disability Assessment Scale [MIDAS] Grade III or IV), cognitive impairment (Migraine Cognitive Impairment Questionnaire [MCIQ]), quality of life (Migraine Specific Quality of Life [MSQ]), allodynia (ASC-12), and functional disability (FDS) were assessed. Linear trend tests, using chi-square for categorical variables and ANOVA for continuous variables, were conducted to determine if the severity of outcomes increased with number of OGPMs.

Results:

In total, 19.6% (472/2404) of US respondents with migraine had ever used at least 1 OGPM (mean [SD] age 43.5 [12.69] years, 72.2% female). Of these, 36.0% (170/472) had used 1 OGPM, 22.9% (108/472) had used 2 OGPMs, and 41.1% (194/472) had used ≥3 OGPMs. Cycling OGPMs was associated with greater disability on MIDAS (1: 54.1% [73/170], 2: 67.6% [73/108], ≥3: 71.6% [139/194]; p=0.024), greater cognitive impairment on MCIQ (1: 67.6% [115/170], 2: 70.4% [76/108], ≥3: 77.8% [151/194], p=0.029) and reduced score on the MSQ role function restrictive domain (mean [SD] 1: 56.9 [22.90]; 2: 53.2 [20.95]; 3: 46.3 [22.51]; p<0.001]). Cycling OGPMs was also associated with increased allodynia and reductions in the performance of daily activities and on MSQ role function preventive and emotional function domains.

Conclusions:

Cycling through OGPMs was associated with greater disability, higher cognitive impairment, and decreased QoL.