Although 38 million Americans have migraine, about half are undiagnosed and undertreated. Even diagnosis is not a guarantee of treatment. Women with obesity who had been diagnosed with migraine did not treat 43% of their attacks, according to a study presented at the American Headache Society scientific meeting June 9-12, 2016.

The study assessed the use of acute medication to treat migraine in real time. Using a smartphone app, patients recorded their medication use at the time of each attack. This gave more accurate data than studies that ask people to recall medication use after the attack is over. Drugs were split into two types: migraine-specific (triptans) and non-migraine specific (OTC painkillers, opioids, and butalbital compounds like Fioricet). 

Of the 57% of attacks that participants treated, the most common single drug used was an NSAID (like Advil/ibuprofen, Aleve/naproxen, and aspirin). Medications used and participants’ frequency of use were:

• NSAIDs: 79.4% of participants used at least once in the 28-day study
• Triptans: 34% used at least once
• Butalbital and/or opioids: 27% used at least once
• Excedrin: 25% used at least once

In the four-week study, most participants used a more than one type of medication to treat their migraine attacks. Headache frequency was highest among women who used butalbital and opioids in addition to other types of acute medications.

Lead researcher Jelena Pavlovic, MD, PhD, pointed out that the study’s findings contradict the belief that medication overuse is an issue for many people with migraine. She said, “There is a long-held misconception that high frequency migraine sufferers overuse medications, but we’ve found that women with migraines and obesity in our sample actually don’t take acute medication as frequently.” In support of other research on medication overuse headache (MOH), this study’s participants with the most frequent migraine attacks took butalbital and opioids, which are considered the most likely culprits for MOH.

“Moreover, the fact that nearly half the attacks go untreated likely indicates significant unmet treatment needs,” Dr. Pavlovic also said. Even with diagnosis, the participants in this study went without migraine treatment during many attacks. The reasons for this are unclear. It could be that the participants are only treating a certain number of attacks to avoid the risk of MOH, they cannot afford to take triptans for every attack, or they use different drugs for different levels of migraine severity.

Participants were part of the Women's Health and Migraine study (WHAM). The purpose of WHAM is to test weight loss as a migraine treatment for women with obesity.

REFERENCE

Pavlovic, J. M.; Lipton, R .B.; Thomas, J. Graham; O’Leary, K.; Roth, J.; Rathier, L.; Evans, E.; Bond, D (2016). Smartphone-Based Ecological Momentary Assessment of Acute Headache Medication Use Patterns in Women with Migraine and Obesity. Proceedings of the 58th Annual Scientific Meeting American Headache Society. San Diego, CA: American Headache Society. Abstract PF17.