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Examination of unmet treatment needs among persons with episodic migraine: results of the American Migraine Prevalence and Prevention (AMPP) Study.

Abstract

BACKGROUND

Despite the expanding therapeutic armamentarium, many people with episodic migraine (EM) have unmet acute treatment needs.

OBJECTIVE

To determine the relative frequency of prespecified types of "unmet treatment needs" in persons with EM in a US population-based sample.

METHODS

Eligible participants completed the 2009 American Migraine Prevalence and Prevention Study survey and met International Classification of Headache Disorders-2nd edition (ICHD-2) criteria for migraine with an average headache day frequency of <15 days per month (EM). We identified 5 domains of unmet treatment needs: (1) dissatisfaction with current acute treatment using 3 summary items from the Patient Perception of Migraine Questionnaire-revised edition (PPMQ-R); (2) moderate or severe headache-related disability defined by a Migraine Disability Assessment Scale score of ≥11; (3) excessive use of opioids or barbiturates defined as use on ≥4 days/month or by meeting Diagnostic and Statistical Manual for Mental Disorders-4th edition criteria for dependence; (4) recurrent use of the emergency department or urgent care clinic for headache defined by ≥2 visits in the preceding year for headache; and (5) history of cardiovascular events indicating a possible contraindication to triptan use. For each respondent, we identified their unmet treatment needs in each category and classified them as having no unmet needs or 1 or more unmet needs.

RESULTS

Of 5591 respondents with EM, 2274 (40.7%) had 1 or more unmet needs; 1467 (26.2%) had exactly 1 unmet need, and 807 (14.4%) had 2 or more unmet needs. Among those with at least 1 unmet need, 1069 (47.0%) had moderate or severe headache-related disability, 851 (37.4%) were dissatisfied with their acute treatment regimen, 728 (32.0%) had excessive opioid or barbiturate use and/or probable dependence, 595 (26.2%) had a history of cardiovascular events, and 129 (5.7%) reported ≥2 visits in the preceding year to the emergency department/urgent care clinic for headache. Persons with more headache days, depression, or generalized anxiety were more likely to have unmet treatment needs.

CONCLUSION

In a population sample of individuals with EM, more than 40% have at least 1 unmet need in the area of acute treatment. The leading reasons for unmet needs, which include headache-related disability and dissatisfaction with current acute treatment, suggest opportunities for improving outcomes for persons with EM.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Albert Einstein College of Medicine, Bronx, NY, USA; Montefiore Medical Center, Bronx, NY, USA.

    , , ,

    Source

    Headache 53:8 2013 Sep pg 1300-11

    MeSH

    Adult
    Cohort Studies
    Female
    Health Services Needs and Demand
    Humans
    Longitudinal Studies
    Male
    Middle Aged
    Migraine Disorders
    Population Surveillance
    Prevalence
    Treatment Outcome
    United States

    Pub Type(s)

    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    23879870

    Citation

    Lipton, Richard B., et al. "Examination of Unmet Treatment Needs Among Persons With Episodic Migraine: Results of the American Migraine Prevalence and Prevention (AMPP) Study." Headache, vol. 53, no. 8, 2013, pp. 1300-11.
    Lipton RB, Buse DC, Serrano D, et al. Examination of unmet treatment needs among persons with episodic migraine: results of the American Migraine Prevalence and Prevention (AMPP) Study. Headache. 2013;53(8):1300-11.
    Lipton, R. B., Buse, D. C., Serrano, D., Holland, S., & Reed, M. L. (2013). Examination of unmet treatment needs among persons with episodic migraine: results of the American Migraine Prevalence and Prevention (AMPP) Study. Headache, 53(8), pp. 1300-11. doi:10.1111/head.12154.
    Lipton RB, et al. Examination of Unmet Treatment Needs Among Persons With Episodic Migraine: Results of the American Migraine Prevalence and Prevention (AMPP) Study. Headache. 2013;53(8):1300-11. PubMed PMID: 23879870.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Examination of unmet treatment needs among persons with episodic migraine: results of the American Migraine Prevalence and Prevention (AMPP) Study. AU - Lipton,Richard B, AU - Buse,Dawn C, AU - Serrano,Daniel, AU - Holland,Starr, AU - Reed,Michael L, Y1 - 2013/07/23/ PY - 2013/04/26/accepted PY - 2013/7/25/entrez PY - 2013/7/25/pubmed PY - 2014/7/16/medline KW - acute treatment KW - cardiovascular risk factors KW - headache-related disability KW - migraine KW - satisfaction KW - unmet need SP - 1300 EP - 11 JF - Headache JO - Headache VL - 53 IS - 8 N2 - BACKGROUND: Despite the expanding therapeutic armamentarium, many people with episodic migraine (EM) have unmet acute treatment needs. OBJECTIVE: To determine the relative frequency of prespecified types of "unmet treatment needs" in persons with EM in a US population-based sample. METHODS: Eligible participants completed the 2009 American Migraine Prevalence and Prevention Study survey and met International Classification of Headache Disorders-2nd edition (ICHD-2) criteria for migraine with an average headache day frequency of <15 days per month (EM). We identified 5 domains of unmet treatment needs: (1) dissatisfaction with current acute treatment using 3 summary items from the Patient Perception of Migraine Questionnaire-revised edition (PPMQ-R); (2) moderate or severe headache-related disability defined by a Migraine Disability Assessment Scale score of ≥11; (3) excessive use of opioids or barbiturates defined as use on ≥4 days/month or by meeting Diagnostic and Statistical Manual for Mental Disorders-4th edition criteria for dependence; (4) recurrent use of the emergency department or urgent care clinic for headache defined by ≥2 visits in the preceding year for headache; and (5) history of cardiovascular events indicating a possible contraindication to triptan use. For each respondent, we identified their unmet treatment needs in each category and classified them as having no unmet needs or 1 or more unmet needs. RESULTS: Of 5591 respondents with EM, 2274 (40.7%) had 1 or more unmet needs; 1467 (26.2%) had exactly 1 unmet need, and 807 (14.4%) had 2 or more unmet needs. Among those with at least 1 unmet need, 1069 (47.0%) had moderate or severe headache-related disability, 851 (37.4%) were dissatisfied with their acute treatment regimen, 728 (32.0%) had excessive opioid or barbiturate use and/or probable dependence, 595 (26.2%) had a history of cardiovascular events, and 129 (5.7%) reported ≥2 visits in the preceding year to the emergency department/urgent care clinic for headache. Persons with more headache days, depression, or generalized anxiety were more likely to have unmet treatment needs. CONCLUSION: In a population sample of individuals with EM, more than 40% have at least 1 unmet need in the area of acute treatment. The leading reasons for unmet needs, which include headache-related disability and dissatisfaction with current acute treatment, suggest opportunities for improving outcomes for persons with EM. SN - 1526-4610 UR - https://www.unboundmedicine.com/medline/citation/23879870/Examination_of_unmet_treatment_needs_among_persons_with_episodic_migraine:_results_of_the_American_Migraine_Prevalence_and_Prevention__AMPP__Study_ L2 - https://doi.org/10.1111/head.12154 DB - PRIME DP - Unbound Medicine ER -