Prevention of medication overuse in clinical practice

The barriers to good medical outcomes for migraine

Suboptimal use of acute and preventive therapies leads to medication overuse

Patients with migraine achieve a good medical outcome when their healthcare journey traverses four barriers, said Professor Buse. Listed in the order in which they feature in a patient’s healthcare journey, these barriers are:

1. Consultation with a medical professional experienced in managing migraine
2. Accurate diagnosis
3. An individualized treatment plan that includes appropriate guideline-based acute and preventive treatment¹
4. Avoidance of suboptimal use of acute and preventive therapies leading to medication overuse^2,3

Failure to traverse these barriers is associated with:

• An increased risk of migraine progression^4,5
• Headache-related disability^2,6
• Psychological symptoms⁴

What proportion of patients with migraine avoid medication overuse?

74.7% of respondents with CM who were correctly diagnosed and received minimally appropriate acute and preventive pharmacologic treatment met acute medication overuse criteria

Professor Buse presented the results of a survey of 16,789 individuals with migraine that evaluated the proportion of people traversing each of the four barriers to achieve a good medical outcome.⁷

Of the 9184 respondents to the US Internet-based Chronic Migraine Epidemiology and Outcomes (CaMEO) study who met the eligibility criteria:

• 1254 had chronic migraine (CM)
• 7930 had episodic migraine (EM)

Only 1.8% of respondents with CM traversed all four barriers

Among respondents with CM, only 1.8% of traversed all four barriers:

• 40.8% reported current headache consultation
• 32.8% of consulters received an accurate diagnosis
• 54.2% of those with an accurate diagnosis received minimally appropriate acute and preventive pharmacologic treatment
• 74.7% of diagnosed and treated consulters met acute medication overuse criteria

Blacks and/or African Americans and multiracial respondents had a higher rate of acute medication overuse

Among respondents with EM, only 8.5% of traversed all four barriers:

• 27.6% reported current headache consultation
• 75.7% of consulters received an accurate diagnosis
• 59.9% of those with an accurate diagnosis received minimally appropriate acute and preventive pharmacologic treatment
• 31.8% of diagnosed and treated consulters met acute medication overuse criteria

A higher income was significantly associated with an increased rate of traversing each barrier.

Blacks and/or African Americans had higher rates of consultation than other racial groups and higher rates of acute medication overuse. Multiracial respondents also had a higher rate of acute medication overuse.