Unmet treatment needs in migraine: Results of the OVERCOME (US) study

OBJECTIVE: To examine acute and preventive migraine prescription treatment needs among participants with active migraine and identify factors associated with needing treatment optimization. BACKGROUND: A high unmet treatment need exists for individuals with migraine. METHODS: ObserVational survey of the Epidemiology, tReatment and Care Of MigrainE (United States) is a prospective, multi-cohort, longitudinal, web-based survey in a demographically representative sample of US adults with active migraine in the preceding year. The current study is a pooled analysis of the baseline surveys of the 2018, 2019, and 2020 migraine cohorts. Criteria for determining need for migraine treatment initiation/modification were based on the American Headache Society 2021 consensus statement. For preventive treatment, need was defined based on the number of headache days per month and Migraine Disability Assessment Scale scores. For acute treatment, need was defined using the Migraine Treatment Optimization Questionnaire scores or based on the presence of two or more disability days per month. Participants were categorized into four groups based on their need for initiation/modification of acute or preventive treatment or both. The categories were "not a candidate (no need for treatment initiation/modification)," "acute need only," "preventive need only," or "preventive + acute needs." Interictal burden was measured using the Migraine Interictal Burden Scale-4. RESULTS: Among 59,001 participants with migraine, 77.1% of the total population were candidates for migraine prescription treatment initiation/modification. Among those, 39.4% had unmet acute needs only, 2.8% had unmet preventive needs only, and 34.9% met criteria for both. Up to one-quarter of participants in each group were taking preventive medication. Acute prescription medication use was reported by 55.7% of those with preventive + acute needs, 46.9% of those with acute needs only, 36.9% of those with preventive needs only, and 27.1% of those who were not candidates for treatment initiation/modification. The highest rate of acute medication overuse was seen in the preventive + acute needs group (37.0%). Over half of the participants in the preventive + acute (69.9%) and acute (58.7%) needs groups reported experiencing moderate-to-severe interictal burden on the Migraine Interictal Burden Scale-4. Migraine-related stigma was highest among those with acute + preventive treatment needs, with 46.4% experiencing stigma often or very often. Experiencing severe interictal burden was most associated with having acute treatment needs (odds ratio [OR], 2.66; 95% confidence interval [CI], 2.48-2.86), whereas overusing acute medication was most associated with having preventive treatment needs (OR, 10.04; 95% CI, 8.64-11.65) and preventive + acute treatment needs (OR, 10.19; 95% CI, 9.09-11.43). CONCLUSION: Over 75% of participants with migraine in this population sample were candidates for initiation or modification of migraine prescription treatment. These findings highlight the opportunity for optimizing treatment and improving outcomes for patients with migraine.