Background: Many existing prescription medications used for migraine prophylaxis are poorly tolerated and less effective than patients desire, frequently leading to treatment discontinuation. The objectives for this study were to gain insight into reasons for patient satisfaction or dissatisfaction with prophylactic migraine medications (PMMs) and identify medication characteristics that would increase patient satisfaction with future PMMs.
Methods: Study participants were recruited by qualitative research facilities across four locations in the United States (Charlotte, NC; St. Louis, MO; Southfield, MI; Tampa, FL). Individuals were eligible to participate if they met the following self-reported criteria: 18 to 55 years old, physician diagnosis of migraine headaches for12 months, current or prior experience taking1 prescription PMM in the past 6 months, experiencing four or more migraine headache days per month, and were further classified as having episodic (EM) or chronic (CM) migraine (based on headache/migraine days reported). Individual discussions with all participants were conducted by two experienced interviewers.
Results: Forty participants were recruited and interviewed; 36 met all eligibility criteria. Twenty-one participants met the criteria for EM, 15 met the criteria for CM, and 4 participants, who were current migraineurs, were unable to be classified as either EM or CM. Participants provided feedback on 20 prescription PMMs. The most commonly used current or prior PMMs were topiramate (n527), amitriptyline (n56), propranolol (n56), onabotulinumtoxinA (n55), and zonisamide (n53). In general, medication effectiveness and tolerability were the most influential factors on patient satisfaction or dissatisfaction with their PMMs. Lack of efficacy was the most frequently reported reason for participants’ dissatisfaction with their medications (56%). In terms of tolerability tolerability, 51% of participants reported that a particular side effect was the most dissatisfying characteristic of their medication. The most bothersome side effects reported by participants were memory loss (n56), dizziness/light-headedness (n55), tiredness/drowsiness/ grogginess/sluggishness (n55), nausea (n53), and dry mouth (n52). Decreased migraine frequency was the most commonly reported driver of participants’ satisfaction with their PMMs (65%), followed by decreased migraine severity/intensity (28%; most commonly described by participants as an inability to function normally or the severity/of migraine symptoms). The most frequently reported desirable characteristics of a new PMM that would increase participants’ satisfaction were related to the medication’s ability to decrease the frequency and severity/ intensity of migraines. Nausea (36%), weight gain (26%), dizziness/light-headedness (23%), drowsiness/ grogginess (15%), and memory loss, including the ability to remember words and speak clearly (13%), are side effects that patients reported they do not want to see in a new or future PMM.
Conclusion: PMM effectiveness and tolerability were key factors influencing treatment satisfaction. There is an unmet need for treatments that have better efficacy and tolerability profiles than existing PMMs.
