Rejection and Acceptance of Possible Side Effects of Migraine Prophylactic Drugs

Authors

  • Pedro A. Kowacs MD,

    1. From the Serviço de Neurologia, Instituto de Neurologia de Curitiba, Curitiba, Brazil (P.A. Kowacs); Serviço de Neurologia, Departamento de Clínica Médica, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (P.A. Kowacs and E.J. Piovesan); Center for Headache and Pain, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA (S.J. Tepper).
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  • Elcio J. Piovesan MD,

    1. From the Serviço de Neurologia, Instituto de Neurologia de Curitiba, Curitiba, Brazil (P.A. Kowacs); Serviço de Neurologia, Departamento de Clínica Médica, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (P.A. Kowacs and E.J. Piovesan); Center for Headache and Pain, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA (S.J. Tepper).
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  • Stewart J. Tepper MD

    1. From the Serviço de Neurologia, Instituto de Neurologia de Curitiba, Curitiba, Brazil (P.A. Kowacs); Serviço de Neurologia, Departamento de Clínica Médica, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (P.A. Kowacs and E.J. Piovesan); Center for Headache and Pain, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA (S.J. Tepper).
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  • Conflict of Interest: Dr. Kowacs gave speeches for GlaxoSmithKline, AstraZeneca, Janssen-Cilag, Merck & Co., and Abbott. He has participated on the Latin American advisory board for Allergan. He has received traveling/meeting grants from Allergan, GlaxoSmithKline, AstraZeneca, Janssen-Cilag, Abbott, Biogen/Schering, and from Serono. He has received payment for research services from GlaxoSmithKline, AstraZeneca, Pfizer, Merck & Co., Bial, Servier, and Nycomed.
    Dr. Piovesan has received traveling/meeting grants from Merck & Co., AstraZeneca, Janssen-Cilag, and Allergan. He has received payment for reserch services from Pfizer.
    Dr. Tepper is on the speaker's bureau with Allergan, Endo Pharmaceuticals, GlaxoSmithKline, Johnson & Johnson, Merck & Co., NMT, and Ortho-McNeil. He is on the advisory board with Allergan, Coherex, Endo Pharmaceuticals, GlaxoSmithKline, Johnson & Johnson, Merck & Co., NMT, NuPathe, and Ortho-McNeil. He is a consultant for Allergan, Coherex, Endo Pharmaceuticals, GlaxoSmithKline, Merck & Co, NMT, and NuPathe. He has received research grants from Allergan, Endo Pharmaceuticals, Forest Labs, GlaxoSmithKline, Johnson & Johnson, Merck & Co., NMT, Ortho-McNeil, and Takeda.

P.A. Kowacs, Instituto de Neurologia de Curitiba, Jeremias Maciel Perretto 300, 81210-310, Curitiba, Brazil.

Abstract

Introduction.— Successful prophylactic therapy might require not only efficacy but meeting patients' expectations about the potential side effects of the preventative drug selected. Prior to prescribing prophylactic drugs to prophylaxis-naive migraine patients, we aimed to quantify the acceptance or rejection of some of the possible adverse events associated with migraine prophylactic drugs.

Methods.— A total of 203 prophylactic-naive migraine/chronic migraine patients, 17 (8.4%) male, 186 (91.6%) female, aged 19 to 65 years were serially selected and asked to answer bidirectional visual numerical scales designed for this purpose, with 1 scale for each side effect. The question posed was: “How much would you accept or reject the following side effects to get rid of your migraine headaches?” The side effects listed were dry mouth, epigastric burning, low energy, tingling, somnolence, depression, tremor, insomnia, memory loss, sluggishness, weight gain, and weight loss.

Results.— The most rejected possible side effects were weight gain, memory loss, and depression. Weight loss was better accepted by patients with a higher body mass. In general, there was a higher acceptance of side effects for patients taking more than 10 symptomatic medications a month, especially for loss of energy and somnolence. Older patients lacked an acceptance of tremor.

Conclusion.— Our findings reinforce and quantify findings similar to those in the literature, and provide new data regarding the preference determinants for prophylactic medication.

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