In the American Migraine Prevalence and Prevention Study, researchers sought to identify predictive factors for acute treatment responses to over-the-counter (OTC) medications in patients with migraine to improve the trial and error process of finding effective OTC options. According to the primary investigator, Ali Ezzati, and colleagues, “predictive models can improve our ability to choose the best therapeutic option for individuals with episodic migraine and increase the proportion of patients with optimized response to treatments.”

In the article in Headache, the investigators also noted that “these results show that response to acute migraine treatments is not optimized in the majority of people with migraine treating with OTC medications.”

The research group developed a predictive model based on the 2006 American Migraine Prevalence and Prevention Study survey. Two components of the Migraine Treatment Optimization Questionnaire were used to evaluate the treatment response, adequate two-hour pain freedom (2hPF), and 24-hour pain relief (24hPR).

Among the cohort of 3,852 patients (79.0% female), 41.6% and 44.6% of participants reported “adequate” 2hPF and 24hPR, respectively. The authors noted that an adequate response to treatment was significantly predicted by lower average headache pain intensity, less cutaneous allodynia, and lower depressive symptom scores. Furthermore, an adequate 2hPF and fewer headache days per month was a predictive factor for adequate 24hPR.

In the 2,168 patients who reported OTC monotherapy, patients who took caffeine-containing combination products (CCP) were reportedly more likely to have adequate 2hPF (odds ratio [OR] = 1.55; 95% confidence interval [CI], 1.23–1.95) and 24hPR (OR = 1.79; 95% CI, 1.18–1.88) when compared to patients taking acetaminophen. Finally, the authors’ predictive models “were modestly predictive of responders to OTC medications (c-statistics = 0.65; 95% CI, 0.62–0.68).”

Overall, Ezzati and the contributing researchers felt that acute migraine treatments were not optimized in the majority of patients using OTC medications and also that predictive models are valuable for selecting the best treatment option for patients with episodic migraines.

Reference: Ezzati, A, Fanning, K, Buse, D, et al. Predictive models for determining treatment response to nonprescription acute medications in migraine: Results from the American Migraine Prevalence and Prevention Study. Headache. 2002;