Predictors of treatment-response to acute prescription medications in migraine: Results from the American Migraine Prevalence and Prevention (AMPP) Study

Objective: To identify predictors of acute treatment optimization with prescription drugs among people with episodic migraine. Methods: A total of 2896 individuals from the American Migraine Prevalence and Prevention study were included in this study. The primary outcome measures of treatment optimization were 2-h pain freedom (2hPF) and 24-h pain relief (24hPR), which were defined by responses to the Migraine Treatment Optimization Questionnaire-6 (mTOQ-6). We identified predictors of 2hPF and 24hPR in response to triptans, butalbital combination medications (BCMs), and opioids. Results:Participants: were on average 47.3 years old (SD=12.0), 85.6 % were female, and 88.4 % were white, 46.9 % of participants reported 2hPF and 49.5 % reported 24hPR with their "usual acute treatment". The odds of adequate 2hPF response were reduced in men and those with higher average headache pain intensity, higher migraine symptom severity scores, presence of cutaneous allodynia, and depression. Adequate 24hPR was associated with being married, but declined in those with higher-than-average average headache pain intensity and frequency, greater disability, presence of cutaneous allodynia, and depression. Among participants reporting acute monotherapy, individuals taking triptans were more likely to have adequate treatment response in comparison with those taking BCMs (2hPF: OR=1.86, 95 %CI 1.42-2.42; 24hPR: OR = 2.26, 95 %CI 1.73-2.96) and opioids (2hPF: OR = 2.39, 95 %CI 1.94-2.96; 24hPR: OR = 2.78, 95 %CI 2.24-3.44). There was no significant difference in response to treatment between the subsample taking BCMs and opioid users. Conclusion: Almost half of study respondents were not optimized on their usual prescription acute migraine treatment(s). Predictive models identified several features associated with treatment optimization.