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Improving Patient Compliance to Prophylactic Migraine Therapy

Published online by Cambridge University Press:  02 December 2014

Michel Aubé
Michel Aubé*
Affiliation:
Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montréal, Québec
*
M. Aubé, 3801 University Street, Montréal, Québec, Canada H3A 2B4
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Abstract

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As in many other chronic conditions, adherence to prophylactic treatment in migraine is probably poor. In chronic diseases, compliance at one year does not exceed 50%. That could explain the low therapeutic gain seen with migraine preventive medications. It also renders difficult the evaluation of clinical trials on migraine prophylaxis since in most of these trials compliance is not properly assessed. From the patients' perspective, there are several factors that could explain poor adherence to recommended treatments. Essentially, these factors are the expression of the patients'subjective perception of their disease and potential remedies in a context of a positive patient-physician relationship. When migraine prophylactic treatment is considered, patients should be informed of the natural history of their disease and a diagnosis of an accelerated form of migraine should be confirmed. Prophylactic treatment at best would reduce by 50% the frequency of migraine attacks. In most studies, however, the therapeutic gain is in the order of 30-40%. Treatment should be instituted for a minimum time of two to three months and if effective maintained for 6-12 months. The outcome of prophylaxis can rarely be determined in a prospective way. The choice of prophylactic regimens remains empirical, often based on the physician's experience and perception of the mechanism of migraine. A better adherence to prophylactic treatment of migraine could possibly improve outcomes but current methods of improving adherence for chronic health problems are mostly complex and not very effective.

Résumé:

RÉSUMÉ:

Comme il en est pour plusieurs maladies chroniques, la fidélité au traitement prophylactique de la migraine demeure probablement faible. On estime que, dans les conditions chroniques, la fidélité au traitement à un an ne dépasse pas 50%. Ceci expliquerait peut-être le faible gain thérapeutique observé avec les agents prophylactiques courants dans la migraine. Un faible taux de fidélité au traitement rendrait aussi difficile l'interprétation des résultats des essais cliniques des agents prophylactiques puisque dans la majorité de ces essais la fidélité au traitement n'est pas mesurée d'une façon adéquate. Du point de vue du patient, plusieurs facteurs peuvent expliquer un faible taux de fidélité. Ils reflètent essentiellement la perception que développe le patient de sa maladie et de son traitement dans un contexte de relation positive avec son médecin. Avant de considérer un traitement prophylactique, le patient doit être informé de l'histoire naturelle de sa condition et un diagnostique d'une forme accélérée de migraine doit être confirmé. Au mieux, le traitement prophylactique réduira de 50% la fréquence des attaques migraineuses. Dans la plupart des études cependant, le gain thérapeutique se limite à 30 à 40%. Pour juger de l'efficacité, le traitement doit être maintenu pour un minimum de 2 à 3 mois et, si efficace, continu pour 6 à 12 mois. Il n'existe que peu d'indices permettant de statuer d'une façon prospective sur l'efficacité d'un traitement. Le choix de l'agent prophylactique demeure empirique, basé sur l'expérience du clinicien et sur sa perception de la pathogenèse de la migraine. Une meilleure fidélité au traitement prophylactique pourrait à la rigueur en améliorer l'efficacité, mais les méthodes courantes visant à améliorer la fidélité des patients demeurent complexes et peu efficaces.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 29 , Issue S2: A Peer-Reviewed Supplement to the Canadian Journal of Neurological Sciences , 2002 , pp. S40 - S43
Copyright
Copyright © The Canadian Journal of Neurological 2002

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