Acute migraine treatment: Patterns of use and satisfaction in a clinical population

Background.-The sequence and timing of taking migraine medications, whether prescription or over-the-counter, and the patient's response to their treatment, is unknown. Objective.-To describe the use of, response to, and satisfaction with acute medications for 1 migraine attack. Methods.-We performed a clinic-based survey of 127 patients at Jefferson Headache Center, Philadelphia. Adult patients who met the International Headache Society criteria for migraine with or without aura were included in the study. Patients were asked to complete a questionnaire. Results.-Of 109 participants who met the inclusion criteria, most waited 1 hour or more after the onset of symptoms to take medication. Triptans were most commonly used as first, second, and third medications. Triptan use was associated with higher 2-hour pain-free response rates compared with other agents, whether the triptan was used as the first, second, or third medication. Patients who were treated with medications other than triptans were more likely to have pain at 2 hours (P = .36). NSAIDs had relatively low pain-free and headache relief response rates at 2 hours. Sixty-two participants (56.9%) had to treat a second time and 31 (28.4%) had to treat a third time. Some participants (17.6%) had headache recurrence within 24 hours after becoming headache free following initial medication and some (23.5%) had recurrence after becoming headache free following their second medication. Sixty-six percent of participants reported being very satisfied/satisfied with their initial medication and 33% were somewhat dissatisfied/dissatisfied to some degree. Even though most patients were satisfied with their medication, 88% reported that they would be willing to try a new antimigraine medication. Most patients (60 [55%]) preferred a long-acting agent versus a rapid-onset, short-acting agent (which was preferred by 49 [45%] patients). Conclusion.-Migraine patients have treatment preferences. They generally want a drug that provides complete headache relief, and they are often satisfied with the current treatment options.