Shah S, Sacco P, Jackson L, Price M, Bensink M, Bernstein C. Beyond frequency alone - exploring what meaningful improvement means in the treatment of migraine: focus groups in patients and health care providers. Poster presented at the 2020 American Headache Society 62nd Virtual Annual Scientific Meeting; June 15, 2020. San Diego, CA.

OBJECTIVE: Current treatment guidelines for migraine focus on reducing migraine frequency as a measure of patients’ meaningful response to pharmacologic treatment. However, other aspects of symptom improvement may be considered important by patients and physicians. The objective of this study was to understand what aspects of symptom and functional improvement are most meaningful to patients with migraine and physicians who care for migraine patients.

A qualitative study was conducted in October 2019 with US patients and health care providers (HCPs). Qualitative data were obtained from a 60-minute focus group discussion with HCPs and two 90-minute focus group discussions, one with episodic (4 to 14 headache days/month) and the other with chronic (15 or more headache days/month) migraine patients. Focus group discussions were moderated using a semi-structured discussion guide; participants were asked to respond to topics using a standard method designed to elicit spontaneous responses and responses to direct probes. The analysis was descriptive. Written notes were verified against audio recordings and summarized systematically.

Seven HCPs (n=3 with 5-15 years, n=4 with 16-25 years in clinical practice) and 16 (8 episodic and 8 chronic) migraine patients (75% female) participated. Themes that arose from episodic and chronic migraine focus group discussions were similar and consistent with HCPs’ views of patients’ migraine experience. With current standard of care therapies, HCPs expressed that it is difficult to manage treatment selection and help patients remain compliant with medication due to side effects and lack of tolerability. For some patients, side effects from standard therapies such as tingling, nervousness, drowsiness, fatigue, nausea, cardiovascular problems and brain fog can be as debilitating as the migraine. There was consensus between HCPs and patients that important measures of meaningful improvement included: 1) reduction in pain, 2) reduction in migraine frequency, 3) resumption of the patients’ day-to-day activities, and 4) associated improvements in relationships, psychosocial impacts, sleep, overall mood and depression. Both patient groups highlighted that they would be able to resume their daily activities more quickly if they had relief of migraine symptoms, which would subsequently benefit their day-to-day, social, and leisure activities.

CONCLUSION: Resumption of day-to-day activities and subsequent impacts on social/emotional function following treatment are aspects of meaningful improvement reported by migraine patients and HCPs caring for patients with migraine. To achieve these improvements, HCPs discussed reductions in pain and migraine frequency while patients highlighted broader symptom relief, including relief from treatment-related side effects. A multitude of factors beyond frequency reduction alone are important and therefore critical to consider when managing migraine and making migraine treatment decisions.

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