title: Examination of unmet treatment needs among persons with episodic migraine: results of the American Migraine Prevalence and Prevention (AMPP) Study.
abstract: BACKGROUND
  Despite the expanding therapeutic armamentarium, many people with episodic migraine (EM) have unmet acute treatment needs.
  
  
  OBJECTIVE
  To determine the relative frequency of prespecified types of "unmet treatment needs" in persons with EM in a US population-based sample.
  
  
  METHODS
  Eligible participants completed the 2009 American Migraine Prevalence and Prevention Study survey and met International Classification of Headache Disorders-2nd edition (ICHD-2) criteria for migraine with an average headache day frequency of <15 days per month (EM). We identified 5 domains of unmet treatment needs: (1) dissatisfaction with current acute treatment using 3 summary items from the Patient Perception of Migraine Questionnaire-revised edition (PPMQ-R); (2) moderate or severe headache-related disability defined by a Migraine Disability Assessment Scale score of ≥11; (3) excessive use of opioids or barbiturates defined as use on ≥4 days/month or by meeting Diagnostic and Statistical Manual for Mental Disorders-4th edition criteria for dependence; (4) recurrent use of the emergency department or urgent care clinic for headache defined by ≥2 visits in the preceding year for headache; and (5) history of cardiovascular events indicating a possible contraindication to triptan use. For each respondent, we identified their unmet treatment needs in each category and classified them as having no unmet needs or 1 or more unmet needs.
  
  
  RESULTS
  Of 5591 respondents with EM, 2274 (40.7%) had 1 or more unmet needs; 1467 (26.2%) had exactly 1 unmet need, and 807 (14.4%) had 2 or more unmet needs. Among those with at least 1 unmet need, 1069 (47.0%) had moderate or severe headache-related disability, 851 (37.4%) were dissatisfied with their acute treatment regimen, 728 (32.0%) had excessive opioid or barbiturate use and/or probable dependence, 595 (26.2%) had a history of cardiovascular events, and 129 (5.7%) reported ≥2 visits in the preceding year to the emergency department/urgent care clinic for headache. Persons with more headache days, depression, or generalized anxiety were more likely to have unmet treatment needs.
  
  
  CONCLUSIONS
  In a population sample of individuals with EM, more than 40% have at least 1 unmet need in the area of acute treatment. The leading reasons for unmet needs, which include headache-related disability and dissatisfaction with current acute treatment, suggest opportunities for improving outcomes for persons with EM.
authors.affiliation: Albert Einstein College of Medicine, Bronx, NY, USA; Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Lipton
authors.forename: Dawn C
authors.initials: DC
authors.lastname: Buse
authors.forename: Daniel
authors.initials: D
authors.lastname: Serrano
authors.forename: Starr
authors.initials: S
authors.lastname: Holland
authors.forename: Michael L
authors.initials: ML
authors.lastname: Reed
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000453:epidemiology* / Q000517:prevention & control*; D011159:Population Surveillance / Q000379:methods*; D015995:Prevalence; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: acute treatment; cardiovascular risk factors; headache-related disability; migraine; satisfaction; unmet need