Migraine attacks can be so disabling, they often interfere with every aspect of a patient's life. Many times people with Migraine have a difficult time finding the right Migraine preventive regime and staying on it. To complicate matters, there's an abundance of medications that can be used for Migraine prevention, on and off-label, all in different drug classes that may add to the confusion.
The Second International Burden of Migraine Study-II (IBMS-II) was a world-wide, online survey taken from January to February 2012 that looked at 600 people with chronic Migraine and 600 people with episodic Migraine. Researchers were interested in the patterns of Migraine preventive medication use in these groups and characterized these patterns in this study.
According to the International Classification of Headache Disorders Revised (ICHD-IIR) Criteria Appendix A 1.5.1 CM is described "as 15 or more headache days per month for at least 3 months, with 8 or more days per month fulfilling criteria for Migraine without aura, in the absence of medication overuse and that cannot be attributed to another causative disorder."¹
People may have EM or CM. CM is seen as a complication of EM and worldwide frequency of it reaches from 1.4% to 2.2%. Data collected from some studies indicate that people with CM opposed to those with EM, suffer more disability, earn less, are less inclined to be employed full-time and are more inclined to have occupational disability. They are also more likely to report depression, anxiety, respiratory and cardiovascular disorders which can all be comorbid conditions with Migraine.
"Our objectives were to assess the differences in preventive medication use relative to sociodemographics and headache-related disability among patients with EM and CM, to characterize patterns of preventive medication use in persons with EM and CM on a multinational basis, and to assess and report reasons for discontinuation of oral preventive medications." ²
- From January, 2010, to February, 2010, investigators conducted an international, online survey of EM and CM participants over the age of 18.
- Participants were from Australia, Canada, France, Germany, the United Kingdom and the United States.
- The Migraine Disability Assessment Scale (MIDAS) was used to determine how disabled the participants were due to Migraine.
- All participants reported having at minimum one headache during the past three months that was not from a cold, flu, hangover or head injury.
- Participants reported various Migraine preventive medications they've tried and/or currently use which included antiseizure drugs, beta blockers, antidepressants, calcium channel blockers, Botox and others.
- Participants were able to choose the reasons they stopped using Migraine preventive medication. These included - satisfactory outcome; no efficacy; side effect issues; cost or other.
- 1165 people responded to the online survey; 42% with CM, 58% with EM.
- 28.3% of EM participants and 44.8% of CM participants currently used Migraine preventive medication.
- 43.4% of EM participants and 65.9% of CM participants stated they were using Migraine preventive medication either currently or previously.
- Migraine preventive medication use was higher in CM participants compared to EM participants.
- The older the participant was and the more Migraine disabled they were, the less likely they seemed to ever have used a Migraine preventive medication, despite attack regularity.
Migraine Preventive Medication Use:
- Almost 61% of EM participants and close to 55% of CM participants used antidepressants.
- Beta blockers were used by 35.4% of EM participants and 36.8% of CM participants.
- 28.6% of EM participants and 36.3% of CM participants used antiseizure medications.
- 13% of EM participants and 18.9% of CM participants used calcium channel blockers.
- 14.3% of EM participants and 16.4% of CM participants used Botox.
Employment of EM and CM participants:
- 47.8% of EM participants who held full time jobs did not use Migraine preventive medication compared to 39% of those with EM who have used or currently use Migraine preventive medication.
- 27.7% of CM participants who held full time jobs did not use Migraine preventive medication compared to 33.3% of those with CM who have used or currently use Migraine preventive medication.
- Both EM participants and CM participants had lower rates of full-time job status when using Migraine preventive medication.
International Migraine preventive medication usage:
- Australia had the highest use of any Migraine preventive medication of all six countries at 78%. Canada had the lowest usage at 56%.
- 61.5% of CM participants in the United States stated they used Migraine preventive medication at some point; 41% of the same group said they are currently using Migraine preventive medication.
- Australia had the highest current Migraine preventive medication use at 62% while the lowest rate was found in Germany at 40.7%.
- 54% of EM participants and 68.4% of CM participants in France have used or are currently using Migraine preventive medication.
- Almost 48% of EM participants and 76% of CM participants in Germany have used or are using Migraine preventive medication.
Reasons for terminating Migraine preventive medication:
- Lack of effectiveness was the number one reason both EM participants and CM participants stopped taking their Migraine preventive medication.
- Between 36.8% and 47.6% of EM participants and between 39.2% and 48.2% of CM participants stopped taking their medication because they felt it was ineffective.
- The numbers of EM participants and CM participants who stopped taking their Migraine preventive medication due to side effects ranged from almost 35% to 49% and 34.2% to 53.2% respectively.
- 9% of CM participants stopped using antidepressants due to Migraine resolution while 19.4% of EM participants did the same.
- 5.6% of CM and 21.7% of EM participants stopped using antiseizure medication due to Migraine resolution.
- 1.4% of CM participants and 24.6% of EM participants stopped using beta blockers due to Migraine resolution.
- 14.3% of EM participants and 5.3% of CM participants stopped using calcium channel blockers due to Migraine resolution.
There are close to 47 million Americans with Migraine and according to researchers it "continues to be an under diagnosed and undertreated disorder."
There was a significant difference in the number attacks in the EM participants. 94% had up to three Migraine days a month and were classified as low frequency; 24% of EM participants had 4-9 Migraine days per month and only 6% had 10-14 Migraine days per month. It appears a large majority of EM participants who took the survey may not be appropriate candidates for Migraine preventive medication.
CM participants stated trying more Migraine preventive medications that the EM participants who according to researchers may mean have a longer history of Migraine or a lack of effectiveness of said medications.
The reason people stopped taking their Migraine preventive medication was due to the medications lack of effectiveness and its side effects. The rate of discontinuation was high for participants with EM, but higher for the CM participants. This survey illustrates the need for effective Migraine preventive treatments seeing as fewer than half the participants with EM and CM are using them.
Comments and Concerns:
While this online survey is interesting, it brings home the point that better treatment options for people with both EM and CM are needed. Because it was an online survey, could there have been misunderstandings about what EM and CM are to the participants? Did EM participants only experience one to two Migraines in the last three months, or was it closer to eight or 10. What if it was 14 Migraines a month, with seven or eight tension-type headaches a month, would they have marked themselves off as CM or EM? Either way, it is clear to see from this survey that not enough people are being treated for Migraine. Thank you for getting us closer to some answers.
¹Headache Classification Subcommittee of the International Headache Society. "The International Classification of Headache Disorders 2nd Edition, 1st Revision." Cephalalgia 2004;24:8-160
²Blumenfeld, Andrew M, MD; Bloudek, Lisa M, PharmD, MS; Becker, Werner J, MD; Buse, Dawn C, PhD; Varon, Sepideh F, PhD; Maglinte, Gregory A, PhD; Wilcox, Teresa, K. PhD; Kawata, Ariane, K, PhD; Lipton, Richard, B. MD. "Patterns of Use and Reasons for Discontinuation of Prophylactic Medications for Episodic Migraine and Chronic Migraine: Results from the International Burden of Migraine Study-II (IBMS-II) Headache. Early View: first published January 4, 2013.
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© HealthCentral Network, 2013.
Last updated February 6, 2013.
Published On: February 06, 2013