Migraineurs let down by prescription medicine

Chronic migraineurs are prescribed medication to help manage their condition; both to alleviate migraine attacks and to prevent them occurring in the first place. These medications are no silver bullet; they work better for some than others. The range of effectiveness varies from patient to patient, as does its side effects.

A new study in the journal Cephalgia points to the low percentage of chronic migraine sufferers who stick to their prescribed, preventative medications. Whether it’s reducing the suggested dose, to completely stopping medication altogether, this trend is a worrying issue for healthcare practitioners to have to deal with. Let’s take a look at this issue in detail.

WHICH MEDICATIONS ARE BEING DISCUSSED?

There are many, many medications offered to chronic migraine patients to help deal with their condition. The study published in Cephalgia is not a comprehensive analysis of adherence rates to every medication being offered. The researchers looked at the following five common preventative medications:

• Propanolol – A common beta-blocker prescribed for a number of health conditions, including angina,high blood pressure, arrythmias, heart failure. Research suggests this drug can help reduce migraines by 60-80 percent
• Topiramate – A common anti-epileptic drug, Topiramate has been judged clinically effective in treating chronic migraines.
• Timolol – A beta-blocker in eye drop form. This drug has been judged effective in chronic migraines; less so for episodic migraines.
• Amitriptylline – This tricyclic antidepressant is commonly prescribed for anxiety and depression. It has also been judged to be effective at managing migraines. (anxiety is a symptom on chronic migraines)
• Divalproex – Another anti-epileptic drug which has been found to be effective in treating chronic migraines. Similarly to Timolol, it is not very effective for episodic migraines.

THE STUDY

Researchers collected data from 8,707 chronic migraineurs (15+ migraines per month). They used this data to track how long patients stuck with their prescribed preventative medication. They also noted when patients switched to alternate preventative medication.

Results were very disappointing for both clinicians and patients. After one month of being prescribed medications, there was what researchers described as ‘a sharp decline’ in patient adherence to medication. Within six months, only 25 percent of people were still taking their prescribed medication. By twelve months, this number had gone down to 14 percent. Those patients who switched medication stopped taking their alternative prescriptions at an equal or higher rate.

DISCUSSION

Something is clearly very wrong with this picture. For Chronic migraine sufferers to feel their medication is so inadequate as to drop off at such high rates should be a wake-up call for healthcare workers everywhere. Chronic Migraine treatment is in dire need of improvement.

Preventative drugs have proven efficacy (via clinical studies) in the treatment of chronic migraines, yet the adherence to prescriptions is very low. Why is this? More research is required to come to certain conclusions; there are obviously many different factors which overlap. Researchers posited one logical explanation as being that ‘these medications are not efficacious and/or produce side effects, and patients do not feel the benefit-risk tradeoff is worthwhile’. Prescription practices not being standardized (the order the medications are prescribed, as well as strength of dose) could also be another reason for lackluster results in treatment of migraines.

‘For chronic migraine sufferers to feel their medication is so inadequate as to drop off at such high rates should be a wake-up call for healthcare workers everywhere’