Patient perceptions and treatment preferences in migraine management

As the characteristics of migraine vary among patients and between attacks, multiple factors must be considered clinically to ensure that patients receive the most effective treatment strategy. Critical information required from the patient is general medical history, migraine-specific history, and the impact of migraine. Once the strategy of care and the optimal therapeutic plan are decided, the choice of therapeutic delivery must take into account patient preferences, compliance and clinical need. During the symposium, a case review and interview with a patient were conducted to illustrate the complex nature of integrating the assessment of signs, symptoms, disability, comorbidities and patient preferences. At the woman's first clinic visit, her Migraine Disability Assessment Scale (MIDAS) score was 70. Previous acute therapies had been only marginally effective, while previous prophylactic therapies had been discontinued because of adverse events or had also proved to be ineffective. The patient's current acute therapy was zolmitriptan 5mg, which she responds to well. Seven months after her first clinic visit, the patient's MIDAS score had decreased to 25. When asked about the relevance and utility of the MIDAS questionnaire, the patient felt that it asked about things that are important, helped her to understand the impact of migraine on her life, and accurately reflected her improvement. The patient also expressed an interest in trying more rapidly acting formulations of migraine-specific therapies in the future, such as a nasal spray formulation of zolmitriptan. The MIDAS questionnaire facilitates communication between physicians and patients to enable greater understanding of the impact of migraine. MIDAS grades can also be used in the stratification of treatment and for monitoring the course of illness and treatment outcomes. By increasing available treatment options, patient needs and preferences can be matched with specific features of migraine therapies. Taking patient preferences into account is likely to increase patient satisfaction and compliance, hopefully decreasing the degree of undertreatment of migraine that has been reported globally.