Pattern and Adherence to Prophylactic Treatment in Migraine: A multi-center study in Egypt

Background & objectives : Prophylactic treatment plays a crucial role in reducing the frequency, severity, and duration of migraine attacks. This cross-sectional study, the first to address this issue in Egypt, aimed to study the patterns of prophylactic treatment utilization among migraine patients and assess adherence levels to prescribed regimens. Methods A cross-sectional study was conducted on 200 migraine patients. Headache was assessed as follows: type of migraine, duration of attacks, frequency of headache per month, disability using the Migraine Disability Assessment Scale (MIDAS) and headache severity using a visual analog scale (VAS), and treatment history including both prophylactic and abortive treatment. Prophylactic treatments were evaluated as regards type, dose, adherence (using Adherence to Refills and Medications Scale (ARMS) and efficacy (using monthly migraine days (MMD), and headache assessment before and after prophylactic medication as well as adherence predictors were assessed. Results The median age of patients was 32 years, with women comprising 70.6% of the cohort. For abortive treatment, paracetamol was the most prescribed medication (42%), followed by triptans (28.4%). Polytherapy with abortive medications was used in 7.8% of cases, primarily among patients with chronic migraine (CM). Regarding prophylactic treatment, 83.3% of patients received monotherapy, with antiepileptic drugs being the most prescribed (40%). Notably, polytherapy regimens demonstrated statistically significant superiority in reducing headache duration, MMD, VAS scores, and MIDAS scores (P < 0.001). However, adherence to prophylactic treatment was low, with only 30.4% of patients maintaining adherence. Multivariate regression analysis identified the use of antidepressants as an independent predictor of adherence. A significant improvement in MIDAS scores was reported among adherent patients after at least three months of prophylactic treatment. This study underscores the need for tailored strategies to enhance adherence to prophylactic therapies and optimize migraine management. Conclusion Non-adherence to prophylactic medication is prevalent among migraine patients in Egypt. The severity of migraine attacks is lower in patients receiving polytherapy regimens; however, using antidepressants is associated with treatment adherence.