Patient values and preferences when treating acute episodic migraine

1. In this rapid review, patients valued effectiveness for treating pain more highly than other attributes such as avoiding harm and reducing other migraine symptoms.

2. However, avoiding harm was also an important consideration, particularly minimizing the risk of nausea.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Several pharmacologic treatments exist for acute migraine, each with different effectiveness for reducing pain and other symptoms, harm profiles, and cost-effectiveness. Considering the importance of individualized therapy, this study aimed to determine patient values and preferences regarding migraine treatments. A rapid review of the existing literature showed that patients valued effectiveness for treating pain more highly than avoiding harm, minimizing cost, or reducing other migraine symptoms such as nausea, vomiting, photophobia, and phonophobia. Among pain effectiveness outcomes, patients preferred speed of onset over degree of pain relief. Patients did also value relief of other migraine symptoms and preferred to avoid drugs that caused nausea. Consistency of effect was the most important attribute for triptan users. Cost-effectiveness was generally not highly valued. The generalizability of this study was limited by the variable quality of the chosen studies, the low certainty of evidence of some findings, the limited age range of participants, the inclusion of patients from only highly developed countries, and the large range of study publication dates, which may make the findings less representative of current populations. Nevertheless, this study described the relative importance of various factors that patients may value when choosing treatments for acute migraine.

Click to read the study in AIM

Relevant Reading: Preferences and perceptions of 617 migraine patients on acute and preventive migraine treatment attributes and clinical trial endpoints

In-Depth [systematic review]: This rapid review aimed to evaluate the factors patients valued the most when deciding on a treatment for acute episodic migraine. Studies involving patients with non-migraine headaches or chronic migraine and studies assessing patient values and preferences only as a secondary focus were excluded. A total of 17 studies were included, yielding a total population of 6568 patients. The average patient age was 35 to 47 years, and 17% to 32% of patients were people of color. Outcomes and attributes were sorted into 4 groups: effectiveness for pain, effectiveness for other symptoms, harms, and other attributes including route of administration and cost-effectiveness. Out of 11 studies that examined effectiveness for pain as well as harm, 10 showed that patients consistently valued effectiveness for pain over avoiding harm. In 9 studies that assessed effectiveness for pain and effectiveness for other migraine symptoms, patients preferred relieving pain over reducing symptoms like nausea, vomiting, photophobia, or phonophobia. Within pain effectiveness outcomes, 2 studies showed that pain relief was more important to patients than a complete absence of pain, while 7 studies showed that patients ranked speed of onset over pain relief. Other symptoms were evaluated in 4 studies, with patients particularly valuing relief of nausea over relieving photophobia, vision problems, or tiredness. Patients considered cost-effectiveness less important than all other outcomes in 3 studies. Overall, this study showed that patients generally preferred acute migraine medications that quickly address pain and cause fewer adverse effects.

Image: PD

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