While this analysis doesn’t allow us to determine why adherence to the preventive medications was so poor (16% at 1 year), we may hazard some guesses based on our experience with how patients use these medications. Based on my clinical experience, the adverse side effect profile and/or the lack of efficacy are the two biggest reasons [for poor adherence].
Sometimes, the adverse event profile prevents increasing the dose of the medications to levels that may be therapeutic, so we never know if the medication might have been effective. However, it’s worth remembering that the best that the currently available preventive drugs can accomplish is to reduce headache days by half or more in about half the patients who take them.
Finally, this cohort had chronic migraine – that means they were a more severely affected group and perhaps less responsive to preventive medications.
Dr. David Dodick is a neurologist and headache specialist at the Mayo Clinic, Scottsdale, Az. He disclosed financial relationships with multiple pharmaceutical companies.
AT THE AAN 2014 ANNUAL MEETING
Allergan sponsored the study. Dr Hepp is a full-time employee of that company.
