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Treating Early Versus Treating Mild: Timing of Migraine Prescription Medications Among Patients With Diagnosed Migraine


  • Kathleen A. Foley PhD,

  • Roger Cady MD,

  • Vincent Martin MD,

  • James Adelman MD,

  • Merle Diamond MD,

  • Christopher F. Bell MS,

  • Jeffrey M. Dayno MD,

  • X. Henry Hu MD, PhD

  • From Outcomes Research and Management, Merck & Co., Inc., West Point, PA (Drs. Foley, Bell, and Hu); Headache Care Center, Primary Care Network, Inc., Springfield, MO (Dr. Cady); Division of General Internal Medicine, University of Cincinnati, Cincinnati, OH (Dr. Martin); Headache Wellness Center, Greensboro, NC (Dr. Adelman); Diamond Headache Clinic, Chicago, IL (Dr. Diamond); and Medical Services, Merck & Co., Inc., West Point, PA (Dr. Dayno).

Address all correspondence to Dr. Kathleen A. Foley, P.O. Box 4, WP39-166, Merck & Co., Inc., West Point, PA 19486.


Introduction.—Although research suggests that early treatment of migraine headache when the pain is mild results in better outcomes for patients, many patients delay taking their acute-migraine medication until their headaches are moderate or severe. Understanding when and why patients use their migraine medications is an important first step to improve migraine management.

Methods.—A prospective observational study, conducted at a major national retail pharmacy chain with stores across the United States between April 2001 and November 2002, enrolled men and women between 18 and 55 years of age with a physician diagnosis of migraine with or without aura. Baseline data on 690 patients included patient demographics, migraine history, medication use, tendency to avoid or delay treatment of a migraine attack, and reasons for delaying treatment. Reasons for delaying treatment were assessed via a checklist of nine potential reasons. In the follow-up survey completed after treatment of the next migraine attack, patients reported the timing of medication use in relation to pain onset and the severity of the migraine headache at the time they took the medication.

Results.—Despite the severity of their typical migraine attacks, approximately 49% of the respondents answered, “yes” to the question, “Do you often avoid or delay taking your migraine medications when you start to experience a migraine attack?” The two most common rationales for avoiding or delaying treatment were “wanting to wait and see if it is really a migraine attack” (69%) followed by “only want to take medications if it is a severe attack” (46%). In the follow-up survey, regardless of medication used, about 85% of patients did not treat their next migraine attack until the headache pain was moderate or severe, although 74% treated within 1 hour of pain onset.

Conclusion.—These results suggest that patients with migraine often delay their treatment until they have identified their attack as a migraine. In addition, while many patients treated their follow-up headache early, they did not treat when the pain was mild. This suggests that there is an opportunity for physicians to educate their migraine patients on how to differentiate migraine from other headache types and about when and how to use their acute-migraine medication.