Prevention of medication overuse in clinical practice

"Medication overuse occurs in nearly 75% of patients with chronic migraine who are correctly diagnosed and receive minimally appropriate acute and preventive pharmacologic treatment", said Professor Dawn Buse, Albert Einstein College of Medicine, NY, at AAN 2021. It results from suboptimal use of acute and preventive therapies and can be prevented by consultation with a medical professional experienced in managing migraine, an accurate diagnosis, and appropriate guideline-based treatment.

The barriers to good medical outcomes for migraine

Suboptimal use of acute and preventive therapies leads to medication overuse

"Patients with migraine achieve a good medical outcome when their healthcare journey traverses four barriers", said Professor Buse. Listed in the order in which they feature in a patient’s healthcare journey, these barriers are:

  1. Consultation with a medical professional experienced in managing migraine
  2. Accurate diagnosis
  3. An individualized treatment plan that includes appropriate guideline-based acute and preventive treatment1
  4. Avoidance of suboptimal use of acute and preventive therapies leading to medication overuse2,3

Failure to traverse these barriers is associated with:

  • An increased risk of migraine progression4,5
  • Headache-related disability2,6
  • Psychological symptoms4

 

What proportion of patients with migraine avoid medication overuse?

74.7% of respondents with CM who were correctly diagnosed and received minimally appropriate acute and preventive pharmacologic treatment met acute medication overuse criteria

Professor Buse presented the results of a survey of 16,789 individuals with migraine that evaluated the proportion of people traversing each of the four barriers to achieve a good medical outcome.7

Of the 9184 respondents to the US Internet-based Chronic Migraine Epidemiology and Outcomes (CaMEO) study who met the eligibility criteria:

  • 1254 had chronic migraine (CM)
  • 7930 had episodic migraine (EM)

Only 1.8% of respondents with CM traversed all four barriers

Among respondents with CM, only 1.8% of traversed all four barriers:

  • 40.8% reported current headache consultation
  • 32.8% of consulters received an accurate diagnosis
  • 54.2% of those with an accurate diagnosis received minimally appropriate acute and preventive pharmacologic treatment
  • 74.7% of diagnosed and treated consulters met acute medication overuse criteria

Blacks and/or African Americans and multiracial respondents had a higher rate of acute medication overuse

Among respondents with EM, only 8.5% of traversed all four barriers:

  • 27.6% reported current headache consultation
  • 75.7% of consulters received an accurate diagnosis
  • 59.9% of those with an accurate diagnosis received minimally appropriate acute and preventive pharmacologic treatment
  • 31.8% of diagnosed and treated consulters met acute medication overuse criteria

A higher income was significantly associated with an increased rate of traversing each barrier.

Blacks and/or African Americans had higher rates of consultation than other racial groups and higher rates of acute medication overuse. Multiracial respondents also had a higher rate of acute medication overuse.

 

AAN : American Academy of Neurology
NY : New York 
CM : chronic migraine
CaMEO : Chronic Migraine Epidemiology and Outcomes 
EM : episodic migraine

BE-NOTPR-0204, approval date : 09.2022 

References
  1. Dodick DW, et al. Assessing barriers to chronic migraine consultation, diagnosis, and treatment: results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study. Headache 2016;56:821–34. 
  2. Lipton RB, et al. Predicting inadequate response to acute migraine medication: results from the American Migraine Prevalence and Prevention (AMPP) study. Headache 2016;56:1635–48.
  3. Bigal ME, et al. Acute migraine medications and evolution from episodic to chronic migraine: a longitudinal population-based study. Headache 2016;48:1157–68.
  4. Schwedt TJ, et al. Factors associated with acute medication overuse in people with migraine: results from the 2017 migraine in America symptoms and treatment (MAST) study. J Headache Pain 2018;19:38.
  5. Bigal ME, Lipton RB. Migraine chronification. Curr Neurol Neurosci Rep. 2011;11:139–48.
  6. Raggi A, et al. Chronic migraine with medication overuse: association between disability and quality of life measures, and impact of disease on patients' lives. J Neurol Sci 2015;348:60–6.
  7. Buse DC, et al. Assessing barriers to care in episodic and chronic migraine: results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study. Neurology 2021;15(Suppl):1144.
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