Preventive Oral Treatment in Migraine: Efficacy and Dropout Rates Observed at a Tertiary Headache Center

To study the short- and long-term effects of preventive treatment in a cohort of migraine patients, enlightening possible predictive factors for ineffectiveness and also analyzing the preventive’s dropout rates, clarifying the underlying reasons. This retrospective analysis included 210 patients who received a diagnosis of migraine without aura (MO), migraine with aura (MA), or chronic migraine (CM), according to ICHD-3 diagnostic criteria, with indication for prophylactic treatment. Three groups were defined and studied regarding the efficacy of oral preventives and dropout rates: group A referred to patients treated with a first preventive, group B with a second, and group C a third, respectively. Overall efficacy of our preventive treatment was low with 40% of patients improving with their first preventive. Also, successive prophylactic attempts were associated with progressively lower rates of efficacy. Patients in whom coexisted MOH (medication overuse headache) had lower rates of preventive inefficacy. The preventive’s dropout rates observed were also high (reaching 63.2% in subgroup C patients) with a dverse drug reactions such as weight gain and cognitive dysfunction being the main reason for this. The modest effect of the oral preventive drugs as well as the high proportion of patients who dropped out due to drug side events confirms that in a significant proportion of patients, oral preventives can only delay a more focused therapeutic approach such as the new therapies with monoclonal CGRP antibodies.