Improving Medication Adherence in Migraine Treatment

Seng, Elizabeth K.; Rains, Jeanetta; Nicholson, Robert A.; Lipton, Richard B.

doi:10.1007/s11916-015-0498-8

Cited by 43 publications

(40 citation statements)

References 32 publications

(34 reference statements)

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“…Adherence with preventive headache medications has predominantly been studied in migraine and adherence to migraine preventives has been found to decline over time ranging from 41 to 95% at 2 months and decreasing to 21 to 80% at 6 months . One recent study using claims data to measure adherence found that amitriptyline had poorer odds of adherence compared to topiramate, the most commonly prescribed medication in their sample . In patients using amitriptyline, adverse events have been cited as the most common reason for stopping .…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Non‐adherence is a problem in many diseases and is multifactorial, related to patient characteristics, medication complexity, the disease being treated, and the method of treatment . A recent review discussing medication adherence in migraine headache prophylaxis provided a few strategies . The most relevant to our study are developing self‐management skills, such as linking medication with daily activity, providing education on how medication adherence is related to treatment outcomes, including setting expectations for preventive medications, and tying medication adherence to an ongoing headache diary .…”

Section: Discussionmentioning

confidence: 99%

“…34 One recent study using claims data to measure adherence found that amitriptyline had poorer odds of adherence compared to topiramate, the most commonly prescribed medication in their sample. 35 In patients using amitriptyline, adverse events have been cited as the most common reason for stopping. 34 In this current study, there was a suggestion of reduced speed of processing in those who took amitriptyline with slower time on Trail Making Test Part B and this may have impacted ongoing use of the medication.…”

Section: Discussionmentioning

confidence: 99%

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Use of Amitriptyline in the Treatment of Headache After Traumatic Brain Injury: Lessons Learned From a Clinical Trial

et al. 2020

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Objectives The primary outcome of this study was to assess the efficacy and safety of preventive treatment with amitriptyline on headache frequency and severity after mild traumatic brain injury (mTBI). Background Despite the fact that headache is the most common and persistent physical symptom after TBI, there has been little research on the longitudinal course or pharmacologic treatment of this disorder. Of those who have headache after injury, about 60% continue to complain of headache at 3 months post injury, with higher levels of disability than those without headache. There have been no prospective, randomized, controlled trials of a pharmacologic agent for headache after TBI. Additionally, a brain‐injured population may be more susceptible to side effects of medication. Design This is a single‐center phase II trial of amitriptyline to prevent persistent headache after an mTBI. Medication dose was gradually increased from 10 to 50 mg daily. Results Fifty participants were enrolled and 33 who completed the 90‐day assessment were included in the final analysis. In order to detect a possible cognitive impact of the study drug, 24 participants were randomly assigned to start amitriptyline immediately after study enrollment and 26 were assigned to start 30 days after enrollment. Forty‐nine percent (18/37) of those assigned to take medication took none throughout the study period, with less compliance in younger participants with mean ages of 32.7 in those who did not take any medication, 33.4 who were less than 80% compliant, and 42.3 who were compliant (P = .013). Compliance in keeping a daily headache diary was low, with 29/50 participants (58%) meeting daily entry completion, and only 10 participants maintaining 100% diary completion. No differences were found between those who started medication immediately vs at day 30 in headache frequency or severity. Conclusions While headache is the most common symptom following mTBI, current evidence does not support a specific treatment. No differences were noted in headache frequency compared to our prior study. However, the current sample had significantly lower headache severity (15% vs 36% with pain rating of 6 or above, P = .015) compared to our prior study. Our current study was not able to determine whether there is any benefit for the use of amitriptyline as a headache preventive because of difficulty with study recruitment and compliance. The challenges with recruitment and retention in the mTBI population were instructive, and future research in this area will need to identify strategies to improve recruitment, diary compliance, and medication adherence in this population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Use of Amitriptyline in the Treatment of Headache After Traumatic Brain Injury: Lessons Learned From a Clinical Trial

et al. 2020

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“…Even an appropriate prescription will fail to help the patient if he does not use the medication adequately. Common examples include the early intake of acute medications and the sufficient duration of a prophylaxis trial . Adequate medications may also fail to help a patient if significant lifestyle issues contributing to migraine frequency are not addressed or if overuse is not managed .…”

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confidence: 99%