Chronic Migraine and Adherence to Oral Preventive Medications

Teri Robert @trobert Health Guide
  • One of the biggest challenges facing people with chronic migraine (CM) is finding an effective preventive regimen. An effective regimen will reduce the number of migraine and headache days we have each month and help get our migraines under better control and down to episodic status. This improves our physical and mental health as well as our quality of life.


    A 2014 study showed that adherence to oral migraine preventive medications is poor, leading one to wonder how much poor adherence contributes to the continuation of chronic migraine. Let's take a look at the study, its results, the researchers' conclusions, and its possible implications.

    Add This Infographic to Your Website or Blog With This Code:

    The Study:

    Study Background and Aim:

    "Chronic migraine (CM) is a disabling disorder characterized by 15 headache days per month that has been shown to significantly reduce quality of life. Migraine-prevention guidelines recommend preventive medications as the standard of care for patients with frequent migraine. The aim of this study was to assess adherence to 14 commonly prescribed oral migraine-preventive medications (OMPMs) among patients with CM."

    Study Methods:

    • Retrospective insurance claims analysis of a U.S. claim database.
      The databases used were Truven MarketScan Databases, which are databases containing inpatient treatment, outpatient treatment, and pharmacy claims for patients who are covered by commercial, Medicare Supplemental, and Medicaid insurance plans was queried to identify patients who:
      • were at least 18 years old
      • were diagnosed with CM
      • who started taking an OMPM (antidepressants, beta blockers, or anticonvulsants) between January 1, 2008 and September 30, 2012.
    • "Medication possession ratios (MPR) and proportion of days covered (PDC) were calculated for each patient."
    • "A cutoff of 80 was used to classify adherence."
    • "The odds of adherence between OMPMs were compared using logistic regression models."
    • In data collection:
      • 121 million patient records were searched.
      • 74,870 patients were identified with CM.
      • 36,720 (49%) started taking an OMPM.
      • 8,688 patients met the study criteria above.

    Study Results:

    • Adherence among patients using all OMPMs was low.
    • At six months, adherence ranged between 26% to 29%.
    • At 12 months, adherence ranged between 17% to 20%.
    • Topiramate (Topamax) was the most commonly prescribed OMPM.
    • Adherence among the 14 OMPMs was similar except for amitriptyline, nortriptyline, gabapentin, and divalproex, which had significantly lower odds of adherence when compared to topiramate.
    • "Some OMPMs, including citalopram (Celexa), fluoxetine (Prozac), venlafaxine (Effexor), atenolol (Tenormin), and metoprolol (Toprol), showed a trend toward an increased likelihood of adherence compared to topiramate (Topamax); however, these results were not statistically significant in most models.

    Study Conclusion:

    "Adherence to OMPMs is low among the US CM population at six months and declines even further by 12 months. Adherence is an important component to successful oral medication therapy and our findings highlight a large gap in care for this highly burdened population."

    My Summary and Comments:

    Oh, my! The results and conclusion of this study are quite enlightening. In the online migraine community, I often see both episodic and chronic migraine patients discuss preventive medications. All too often, they don't give oral preventive medications a fair trial, which for most oral medications, is at least 90 days. Sometimes, it's the patient's decision to stop taking a medication. Sometimes, doctors change the patient's medications before they're taken long enough for a fair trial. In the event of serious side effects, of course, the trial should be stopped. Too frequently, however, even mild side effects that could stop over time precipitate the discontinuation of a medication.


    Add This Infographic to Your Website or Blog With This Code:

    Research has shown that patients who are educated about their health issues are more compliant with their treatment plans and have better outcomes. Sadly, in today's medical practices, time for patient education is often lacking. I have to wonder if adherence rates are negatively affected by a lack of patient education. Could adherence be improved by educating patients about the medications that are prescribed for them and how vital adherence is to their success with preventive treatments? I'd love to have fewer patients coming online for their questions about their medications. The responsibility for this lies with both patients and doctors. Doctors should educate us about the medications they prescribe, and when they don't, we should speak up and ask for information.




    Hepp, Zsolt; Dodick, David W.; Varnon, Sepideh F.; Gillard, Patrick; Hansen, Ryan N.; Devine, Emily B. "Adherence to oral migraine-preventive medications among patients with chronic migraine." Cephalalgia. OnlineFirst. Published online before print. August 27, 2014.


    Live well,

    PurpleRibbonTiny Teri1


    Make a difference... Donate to the 36 Million Migraine Campaign!


    Follow me on    or 


    Reviewed by David Watson, MD.

    Page copy protected against web site content infringement by Copyscape

    © Teri Robert, 2014, •  Last updated October 28, 2014.


Published On: October 28, 2014