Noncompliance May Render Migraine Prophylaxis Useless, But Once-Daily Regimens Are Better

Medicines work better if taken, which must be true of migraine prophylaxis. There is evidence that compliance with regular medication can be badly deficient. To assess how serious the problem might be in routine migraine management, we undertook a covert observational 2-month survey in a specialist...

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Veröffentlicht in:Cephalalgia 1998-01, Vol.18 (1), p.52-56
Hauptverfasser: Mulleners, WM, Whitmarsh, TE, Steiner, TJ
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container_title Cephalalgia
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Whitmarsh, TE
Steiner, TJ
description Medicines work better if taken, which must be true of migraine prophylaxis. There is evidence that compliance with regular medication can be badly deficient. To assess how serious the problem might be in routine migraine management, we undertook a covert observational 2-month survey in a specialist headache clinic using objective measures of compliance. Subjects were 38 patients needing prophylaxis with medication prescribed once (od), twice (bd), or three times daily (tds). Medication was dispensed, unknown to them, in Medication Event Monitoring Systems (MEMS) to record openings in real time. Number, timing, and pattern of actual openings were compared with what was expected. Compliance rates averaged 66%, although returned pill counts indicated 91%. A substantial and significant difference was shown between od and bd or tds regimens. Measures of dosing interval—used-on-schedule rate and therapeutic coverage—averaged between 44% and 71%. Once-daily treatment was associated with a used-on-schedule rate more than double those of multiple daily dosing, but still only 66%. We conclude that routine use of drug prophylaxis in migraine may be so seriously undermined by poor compliance that it has little chance of efficacy. Returned-pill counting is inadequate for compliance assessment.
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There is evidence that compliance with regular medication can be badly deficient. To assess how serious the problem might be in routine migraine management, we undertook a covert observational 2-month survey in a specialist headache clinic using objective measures of compliance. Subjects were 38 patients needing prophylaxis with medication prescribed once (od), twice (bd), or three times daily (tds). Medication was dispensed, unknown to them, in Medication Event Monitoring Systems (MEMS) to record openings in real time. Number, timing, and pattern of actual openings were compared with what was expected. Compliance rates averaged 66%, although returned pill counts indicated 91%. A substantial and significant difference was shown between od and bd or tds regimens. Measures of dosing interval—used-on-schedule rate and therapeutic coverage—averaged between 44% and 71%. Once-daily treatment was associated with a used-on-schedule rate more than double those of multiple daily dosing, but still only 66%. We conclude that routine use of drug prophylaxis in migraine may be so seriously undermined by poor compliance that it has little chance of efficacy. 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Whitmarsh, TE ; Steiner, TJ</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4512-5cc04cd25ac0f89dab0b36fc45977d8fe308c743082483c6b3d1754b0cc0435f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1998</creationdate><topic>Administration, Oral</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Analgesics, Non-Narcotic - administration &amp; dosage</topic><topic>Atenolol - administration &amp; dosage</topic><topic>Compliance</topic><topic>Dose-Response Relationship, Drug</topic><topic>dosing regimen</topic><topic>Drug Administration Schedule</topic><topic>Drug Monitoring</topic><topic>efficacy</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>medication event monitoring systems</topic><topic>Methysergide - administration &amp; dosage</topic><topic>Middle Aged</topic><topic>Migraine Disorders - prevention &amp; control</topic><topic>migraine prophylaxis</topic><topic>Pizotyline - administration &amp; dosage</topic><topic>Propranolol - administration &amp; dosage</topic><topic>Sympatholytics - administration &amp; dosage</topic><topic>Treatment Refusal</topic><topic>Vasoconstrictor Agents - administration &amp; dosage</topic><topic>Vasodilator Agents - administration &amp; dosage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mulleners, WM</creatorcontrib><creatorcontrib>Whitmarsh, TE</creatorcontrib><creatorcontrib>Steiner, TJ</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Cephalalgia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mulleners, WM</au><au>Whitmarsh, TE</au><au>Steiner, TJ</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Noncompliance May Render Migraine Prophylaxis Useless, But Once-Daily Regimens Are Better</atitle><jtitle>Cephalalgia</jtitle><addtitle>Cephalalgia</addtitle><date>1998-01</date><risdate>1998</risdate><volume>18</volume><issue>1</issue><spage>52</spage><epage>56</epage><pages>52-56</pages><issn>0333-1024</issn><eissn>1468-2982</eissn><abstract>Medicines work better if taken, which must be true of migraine prophylaxis. There is evidence that compliance with regular medication can be badly deficient. To assess how serious the problem might be in routine migraine management, we undertook a covert observational 2-month survey in a specialist headache clinic using objective measures of compliance. Subjects were 38 patients needing prophylaxis with medication prescribed once (od), twice (bd), or three times daily (tds). Medication was dispensed, unknown to them, in Medication Event Monitoring Systems (MEMS) to record openings in real time. Number, timing, and pattern of actual openings were compared with what was expected. Compliance rates averaged 66%, although returned pill counts indicated 91%. A substantial and significant difference was shown between od and bd or tds regimens. Measures of dosing interval—used-on-schedule rate and therapeutic coverage—averaged between 44% and 71%. Once-daily treatment was associated with a used-on-schedule rate more than double those of multiple daily dosing, but still only 66%. We conclude that routine use of drug prophylaxis in migraine may be so seriously undermined by poor compliance that it has little chance of efficacy. Returned-pill counting is inadequate for compliance assessment.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>9601625</pmid><doi>10.1046/j.1468-2982.1998.1801052.x</doi><tpages>5</tpages></addata></record>
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subjects Administration, Oral
Adolescent
Adult
Aged
Analgesics, Non-Narcotic - administration & dosage
Atenolol - administration & dosage
Compliance
Dose-Response Relationship, Drug
dosing regimen
Drug Administration Schedule
Drug Monitoring
efficacy
Female
Humans
Male
medication event monitoring systems
Methysergide - administration & dosage
Middle Aged
Migraine Disorders - prevention & control
migraine prophylaxis
Pizotyline - administration & dosage
Propranolol - administration & dosage
Sympatholytics - administration & dosage
Treatment Refusal
Vasoconstrictor Agents - administration & dosage
Vasodilator Agents - administration & dosage
title Noncompliance May Render Migraine Prophylaxis Useless, But Once-Daily Regimens Are Better
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