Adherence to migraine prophylaxis at a Swedish tertiary clinic. A cross-sectional study of influence of disease features

• Introduction The efficacy of mainly the more recently developed prophylactic treatments of migraine have been well established in a large number of randomised controlled trials. However, such trials tend to focus on the effects of the drug in an ideal setting and rather underestimate the impact of non-compliance, which generally escapes detection by the physician. This poorly understood phenomenon was further looked at in a naturalistic setting. Methods A consecutive sample of 175 migraineurs (85% women, mean age 4512, range 19-79 years) with a current prescription of pharmacological prophylaxis were studied at a Swedish headache specialist clinic. Adherence was self-reported with the Medication Adherence Report Scale (MARS, possible range of scores 5-25). Logistic regression analysis was performed to analyze the association between MARS and frequency of attacks, number of days with migraine per month, attack duration, presence of prodrome (68%), presence of aura (41%, some or all attacks), mean intensity of pain, and recovery between attacks. Results The mean frequency of migraine was 6.5 days / month, and 68% did not recover completely interictally. The mean MARS score was 22.52.8. One third (35%) was not highly adherent. Neither demographic characteristics, nor any of the studied disease specific variables were significantly associated with adherence. Discussion The full benefit of prophylactic migraine medication cannot be realised at currently achieved levels of adherence. Characteristics of the headaches per se are the starting point of patients’ decision-making. However, the present study indicates that other factors play a more important role in this complicated process.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Neurologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Neurology (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Medicinska och farmaceutiska grundvetenskaper -- Samhällsfarmaci och klinisk farmaci (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Basic Medicine -- Social and Clinical Pharmacy (hsv//eng)

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