Researchers of a study aimed to recognize predictors of acute treatment optimization for migraine using over the counter (OTC) or prescription nonsteroidal anti-inflammatory drugs (NSAIDs) in addition to other commonly used OTCs (acetaminophen, caffeine combination products [CCPs], acetylsalicylic acid [ASA; aspirin]) in patients with episodic migraine, creating prediction treatment response models in each OTC class. Using the American Migraine Prevalence and Prevention study data, 2,224 patients who were aged at least 18 years, met migraine criteria, had less than 15 monthly headache days, and had reported use of a monotherapy in one of the studied drug classes for acute migraine attacks (CCP [N = 711]; acetaminophen [N = 643]; ASA [N = 110]; prescription or OTC NSAIDs [N = 760]) were included in the study.

Better 2-hour pain freedom and 24-hour pain freedom was found in those using CCPs. NSAIDs were associated with lower pain intensity, cutaneous allodynia, symptoms of depression, and Migraine Disability Assessment Scale grade. It was concluded that a sizeable subgroup of those with migraine experienced inadequate response to their typical OTC treatment for acute migraine 2- and 24-hours post dose, highlighting the need for improvement in OTC treatments for some patients, while offering prescriptions for acute medications to other patients. Researchers noted that the predictive models were able to recognize various factors linked with better response to treatment for each class of OTCs.

Reference: Ezzati A, Fanning KM, Reed ML, Lipton RB. Predictors of treatment-response to caffeine combination products, acetaminophen, acetylsalicylic acid (aspirin), and nonsteroidal anti-inflammatory drugs in acute treatment of episodic migraine [published online ahead of print, 2023 Feb 7]. Headache. 2023;10.1111/head.14459. doi:10.1111/head.14459