Use and Overuse of Antimigraine Drugs by Pharmacy Personnel in France: COTA Survey

Background.- Pharmacy personnel are supposed to be well informed of recommendations for proper migraine management, but their easy access to medicines may favor self-medication and promote medication overuse for those with frequent migraine attacks. Objective.- The main objective of the COTA survey was to investigate migraine management by pharmacy personnel who considered themselves as migraineurs. Methods.- Out of 22,000 pharmacies currently open in France, a questionnaire was proposed to a random sample of similar to 4000 pharmacies with at least 1 self-considered migraineur in the pharmacy staff who accepted to complete and return the questionnaire. The reality of migraine was assessed by the study questionnaire according to the International Classification of Headache Disorders, 2nd edition (ICHD-II) criteria. In addition, the study questionnaire inquired about subjects' demographics, headache characteristics, consumption of medications for headaches, subjects' satisfaction with the usual treatment of headaches and treatment effectiveness. Medication overuse was defined in terms of treatment days per month during the previous 3 months according to the ICHD-II criteria for medication overuse headache. Results.- Some 74% of the 3326 participating pharmacies with a self-considered migraine subject among their staff actually returned the survey questionnaire. Using the ICHD-II criteria, migraine was confirmed in 85% of participating subjects, of whom 38% were under medical supervision and had asked for a prescription, and 27% used recommended medications. The treatment used was truly effective for only 31% of migraineurs. Medication overuse was observed in 21% of all participating subjects, mostly migraineurs. Most migraineurs with medication overuse (81%) used nonrecommended treatments. Conclusions.- Considering their pivotal role in advising migraine patients who seek their help with self-management, migraine education of pharmacy personnel about proper migraine management should be reinforced.