Acute migraine medication adherence, migraine disability and patient satisfaction: A naturalistic daily diary study

Objective: To examine the influence of acute migraine medication adherence on migraine disability and acute medication satisfaction. Methods: Adults with migraine completed three months of daily electronic diaries assessing headache symptoms, acute medication taken, acute medication satisfaction, and daily migraine disability. Repeated measures mixed-effects models examined the effect of initial medication type [migraine-specific medication (MSM) vs. over-the-counter analgesic (OTC) vs. an opiate/barbiturate], the severity of pain at dosing, and their interaction with daily migraine disability and satisfaction with acute medication. Results: Participants (N = 337; 92.5% female; 91.1% Caucasian, non-Hispanic; 84.0% with episodic migraine) recorded 29,722 diary days. Participants took acute medication on 96.5% of 8090 migraine days. MSM was most frequently taken first (58%), followed by OTC (29.9%) and an opiate/barbiturate (12.1%). Acute medication was most frequently taken when pain was mild (41.2%), followed by moderate (37.7%) and severe pain (11.4%). Initially dosing with MSM while pain was mild was associated with the lowest daily disability [medication x pain at dosing F (4, 6336.12) = 58.73, p<. 001] and highest acute medication satisfaction [medication x pain at dosing F (4, 3867.36) = 24.00, p<. 001]. Conclusion: Using an MSM (triptan or ergot) first was associated with the lowest migraine disability and highest acute medication satisfaction.