Responsiveness of migraine-ACT and MIDAS questionnaires for assessing migraine therapy.
ABSTRACT Migraine is frequently undertreated. The 4-item Migraine Assessment of Current Therapy (Migraine-ACT) questionnaire is a simple and reliable tool to identify patients requiring a change in current acute migraine treatment. Objective: To investigate the responsiveness of the Migraine-ACT tool, and compare it with that of the Migraine Disability Assessment (MIDAS) questionnaire, for patients with migraine at 1100 primary care sites in Spain.
Patients eligible for this open-label, 2-visit prospective study reported migraine for >1 year and >or=1 migraine attack per month and were new to the clinic or on follow-up care for <6 months. Validated Spanish versions of the Migraine-ACT and MIDAS questionnaires were administered, and patient satisfaction with treatment was recorded, at baseline and at 3 months.
A total of 3272 patients, 78% female, were enrolled, and 2877 (88%) returned for the 3-month visit. Investigators changed baseline migraine treatment for 72% of returning patients; 85% and 80% of these patients had improved Migraine-ACT and MIDAS scores at 3 months, respectively. Patients who reported being completely or very satisfied with migraine treatment numbered 492 (15%) at baseline and 1406 (49%) at 3 months. Migraine-ACT and MIDAS score agreement for improvement at 3 months was poor (kappa = 0.339). Both the mean MIDAS score and the distribution of Migraine-ACT scores improved over the course of 3 months; however, Migraine-ACT scores were significantly (P < .001) more sensitive (83% vs 75%) and specific (72% vs 58%) than MIDAS scores. The area under the curve in the receiver-operating characteristic analysis was significantly (P < .0001) greater for Migraine-ACT (0.82) as compared with the MIDAS (0.70) questionnaire.
These results suggest that the Migraine-ACT questionnaire can be used more reliably than the MIDAS questionnaire for detecting improvements in treatment of new and follow-up patients with migraine.
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ABSTRACT: We asked whether attempts to introduce headache services in poor countries would be futile on grounds of cost and unsustainability. Using data from a population-based survey in the Republic of Georgia, an exemplary poor country with limited health care, and against the background of headache-attributed burden, we report on willingness to pay (WTP) for effective headache treatment. Consecutive households were visited in areas of Tbilisi (urban) and Kakheti (rural), together representative of Georgian habitation. Biologically unrelated adults were interviewed by medical residents using a structured ICHD-II-based diagnostic questionnaire, the MIDAS questionnaire and SF-36. The bidding-game method was employed to assess WTP. Of 1,145 respondents, 50.0% had episodic headache (migraine and/or tension-type headache) and 7.6% had headache on ≥15 days/month, which was not further diagnosed. MIDAS scores were higher in people with headache on ≥15 days/month (mean 11.2) than in those with episodic headache (mean 7.0; P = 0.004). People with headache had worse scores in all SF-36 sub-scales than those without, but no differences were found between headache types. Almost all (93%) respondents with headache reported WTP averaging USD 8 per month for effective headache treatment. WTP did not correlate with headache type or frequency, or with MIDAS or SF-36 scores. Headache is common and headache-attributed burden is high in Georgia, with a profound impact on HRQoL. Even those less affected indicated WTP for effective treatment, if it were available, that would on average cover costs, which locally are low. Headache services in a poor country are potentially sustainable.The Journal of Headache and Pain 11/2011; 13(1):67-74. · 2.78 Impact Factor
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ABSTRACT: To assess the influence of switching acute treatment on headache-related disability in a population sample of individuals with migraine using acute triptan therapy. Acute treatments for migraine are often modified in clinical practice. The effect of changes in treatment from one triptan to another or from a triptan to another medication class has rarely been studied. Patterns of acute treatment for migraine were monitored from 1 year to the next in the American Migraine Prevalence and Prevention (AMPP) Study for the following couplets (2005-2006, 2006-2007, 2007-2008, and 2008-2009). Changes in medication regimens were classified as follows: (1) switch within the triptan class; (2) switch to combination analgesics containing opioids or barbiturates; (3) switch to non-steroidal anti-inflammatory drug (NSAID) agents; (4) maintaining current therapy (consistent use, "control"). We assessed change in migraine disability assessment scale score from the first to the second year of a couplet contrasting those with consistent use with those who changed acute treatment. Each individual contributed only 1 couplet to the analysis. Persons who added an acute treatment are considered in a separate manuscript. We modeled change in migraine disability assessment scale score as a function of change in medication regimen with consistent users as the control group. We identified 81 individuals who switched to another triptan, with a referent of 619 who remained consistent, 31 cases who switched to an opioid or barbiturate with a referent of 666 who remained consistent, and 20 cases who switched to an NSAID with a referent of 667 cases who remained consistent. In cell-mean coded analyses of covariance (ANCOVA), switching from one triptan to another or switching from a triptan to an opioid/barbiturate was never associated with significant improvements in headache-related disability compared with consistent treatment. Switching from a triptan to an NSAID was associated with significant increases in headache-related disability among those with high-frequency episodic/chronic migraine (HFEM/CM) compared with those with low-frequency episodic migraine (LFEM) (interaction = 34.81, 95% confidence interval 10.61 to 59.00). The same was true comparing high-frequency episodic/chronic migraine with those with moderate-frequency episodic migraine (interaction = 48.73, 95% confidence interval 2.63 to 94.83). In this observational study, switching triptan regimens does not appear to be associated with improvements in headache-related disability and in some cases is associated with increased headache-related disability.Headache The Journal of Head and Face Pain 05/2013; · 2.94 Impact Factor
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ABSTRACT: Background.— Although diagnostic rates for migraine have increased over the past 5 years, the proportion of migraine sufferers using triptans has remained essentially stable.Objectives.— To assess the rate of onset of new triptan prescriptions among persons with migraine and the predictors of initiating therapy.Methods.— The American Migraine Prevalence and Prevention Study is a longitudinal study conducted in a representative sample of headache sufferers in the US population. Episodic migraineurs not using triptans in 2005 who continued to have migraine and provided treatment data in 2006 (n = 6865) were included. We assessed predictors of triptan use in univariate and multivariate analyses, including 3 nested models. In Model 1, we adjusted for demographic variables. Model 2 added headache-related disability and cutaneous allodynia. Model 3 added depression and use of preventive headache medications.Results.— Among individuals not using triptans in 2005, triptan use in 2006 occurred in 4.9% of the sample. In unadjusted analyses, gender and race were not associated with use of triptan. Use was lower in those aged 60 years or more vs those 18-29 (odds ratio [OR] = 0.4, 95% confidence interval [CI] = 0.2-0.7, P = .001). Taking individuals with no disability as the reference, mild (OR = 1.44, 95% CI = 1.03-2.01, P = .03), moderate (OR = 1.54, 95% CI = 1.1-2.2, P = .01) and severe disability (OR = 2.19, 95% CI = 1.55-3.09, P < .0001) predicted triptan use. In the adjusted models, age, income, insurance, disability and preventive medication use were associated with triptan use. Gender, race, education and depression were not.Conclusions.— New use of triptans is low in the population. Because adequacy of care was not assessed, future studies should focus on investigating whether this low rate of triptan start is proper or if it reflects an unmet treatment need.Headache The Journal of Head and Face Pain 05/2010; 50(9):1440 - 1448. · 2.94 Impact Factor