This study examined patient-specific and headache-specific factors that predict non-adherence with acute migraine medications (AMM) guidelines.

The treatment guidelines for AAM dictate that medication should be taken early in the attack and used no more than fifteen days a month for simple analgesics or ten days for other AMMs. Non-adherence to these guidelines leads to increased migraine-related disability and increased headache frequency.

193 migraine patients with triptan or ergot prescriptions from a Midwest healthcare system completed a survey of demographic information (including education, personal income, and gender) and a three-month electronic headache diary (including the characteristics of each attack and medication use). The triptan or ergot was classified as taken early if it was used when the pain was mild.  Odds ratios as to whether the patient- and headache- specific factors were associated with early AMM use were conducted using generalized estimating equations with confidence intervals of 95%.

Participants were 91.7% female, 92.2% Caucasian, ages 18-64.  55.8% had personal incomes >50K annually and 63.7% had an undergraduate degree. Compared to migraine attacks with no nausea, migraine attacks with nausea (OR=0.22 CI 0.16-0.33) or nausea and vomiting (OR=0.04 CI 0.02-0.18) were associated with lower odds of using AAM early. Participants with annual incomes >50K a year had higher odds of taking AAM compared to participants with incomes <=50K (OR 2.04 CI 1.33-3.12). Female gender, having an undergraduate degree, and having >=15 headaches per month were not associated with early AMM use (ps>0.05)

Nausea with and without vomiting during a migraine attack is associated with non-adherence to AMM guidelines.  This may indicate under-utilization of non-oral AMMs.  People with lower incomes are less likely to adhere to AMM guidelines, which may indicate insufficient access to more effective or non-oral AMMs that may be more costly.