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Preventive Oral Treatment in Migraine: Efficacy and Dropout Rates Observed at a Tertiary Headache Center

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Abstract

To study the short- and long-term effects of preventive treatment in a cohort of migraine patients, enlightening possible predictive factors for ineffectiveness and also analyzing the preventive’s dropout rates, clarifying the underlying reasons. This retrospective analysis included 210 patients who received a diagnosis of migraine without aura (MO), migraine with aura (MA), or chronic migraine (CM), according to ICHD-3 diagnostic criteria, with indication for prophylactic treatment. Three groups were defined and studied regarding the efficacy of oral preventives and dropout rates: group A referred to patients treated with a first preventive, group B with a second, and group C a third, respectively. Overall efficacy of our preventive treatment was low with 40% of patients improving with their first preventive. Also, successive prophylactic attempts were associated with progressively lower rates of efficacy. Patients in whom coexisted MOH (medication overuse headache) had lower rates of preventive inefficacy. The preventive’s dropout rates observed were also high (reaching 63.2% in subgroup C patients) with adverse drug reactions such as weight gain and cognitive dysfunction being the main reason for this. The modest effect of the oral preventive drugs as well as the high proportion of patients who dropped out due to drug side events confirms that in a significant proportion of patients, oral preventives can only delay a more focused therapeutic approach such as the new therapies with monoclonal CGRP antibodies.

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Data Availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Authors and Affiliations

  1. Neurology Department, Hospital de Braga, Rua das Comunidades Lusíadas 133, Braga, Portugal

    Andreia Ferreira, Sofia Reis Marques, Sofia Lopes, Ricardo Maré, Gisela Carneiro, Margarida Lopes & Sara Varanda

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  1. Andreia Ferreira
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  2. Sofia Reis Marques
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  3. Sofia Lopes
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  6. Margarida Lopes
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Contributions

All the authors were involved in the conception of the work and the acquisition, analysis an interpretation of data. A.F and S.M. were responsible for drafting of the work, revising it critically for important intellectual content and agreement in all aspects related to the accuracy or integrity.

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Correspondence to Andreia Ferreira.

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This study was approved by the local Ethics Committee—Ethics and health commission of Hospital of Braga, Portugal.

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Oral informed consent for inclusion in the study were obtained from all subjects.

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Ferreira, A., Marques, S.R., Lopes, S. et al. Preventive Oral Treatment in Migraine: Efficacy and Dropout Rates Observed at a Tertiary Headache Center. SN Compr. Clin. Med. 5, 38 (2023). https://doi.org/10.1007/s42399-022-01369-w

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