Brief Migraine Questionnaire Could Help
PCPs Better Assess, Manage Treatment

BY JOHN R. BELL
Elsevier Global Medical News

BOSTON (EGMN) - A new five-question survey for patients to report the efficacy and tolerability of their migraine medications should help primary care physicians quickly discover any problems with treatment, according to Dr. Richard B. Lipton, who led the group of neurologists who developed and tested the questionnaire.

Dr. Lipton, of the Albert Einstein College of Medicine, New York, presented findings from those tests in a poster presentation on May 3 at the annual meeting of the American Academy of Neurology.

He and his colleagues developed the Migraine Treatment Optimization Questionnaire (M-TOQ) to address "a large gap... between evidence-based migraine treatment guidelines and actual clinical practice" and the corresponding absence of a single tool to assess patients' satisfaction with their migraine treatment.

They began with a 19-item written questionnaire, with each question answerable with a "yes" or "no." Questions ask about the effectiveness, tolerability, and side effects of migraine medication. They then tested the 19-item M-TOQ on 253 patients at 25 sites in the United States, Canada, Germany, Italy, Spain, and France. Patients were at least 18 years old and met the International Classification of Headache Disorders criteria for migraine with or without aura as well as the International Classification of Headache Disorders, Second Edition, criteria for migraine with or without aura; 90% of patients were female, and 69% had experienced migraine for more than 10 years. Exclusion criteria were frequent nonmigrainous headache, use of a psychotropic medication in the last 3 months, alcohol or drug dependency, or any acute or unstable illness in the last 3 months.

All participants completed (administered in the local language) the Migraine Disability Assessment Scale (MIDAS), the Headache Impact Test (HIT-6), and the Migraine-Specific Quality of Life Scale (MSQoL), to confirm the scale validity of the M-TOQ and to detect any redundancy.

The investigators then conducted a three-step statistical analysis. The first was pool reduction, or minimizing the number of questions while maintaining adequate coverage of five clinical outcome domains. These domains were consistency of relief, functioning, recurrence, side effects, and rapid symptom relief. An assessment of scale validity followed, along with an evaluation of test-retest reliability.

These steps narrowed the field of questions to five:
-"Are you able to quickly return to your normal activities (that is, work, family, leisure, social activities) after taking your migraine medication?"
-"Can you count on your migraine medication to relieve your pain within 2 hours for most attacks?"
-"Does one dose of your migraine medication usually relieve your headache and keep it away for at least 24 hours?"
-"Is your migraine medication well tolerated?"
-"Are you comfortable enough with your migraine medication to be able to plan your daily activities?"

Subsequent analyses revealed that M-TOQ had high test reliability and high test-retest validity and that M-TOQ also showed modest positive correlations with the MIDAS, HIT-6, and MSQoL scales - enough to demonstrate scale validity but not so much as to make the M-TOQ redundant, Dr. Lipton said in an interview.

The commonly used MIDAS scale was developed by Dr. Lipton, but "most primary care doctors probably don't use any tool" to assess migraine treatment efficacy, he said. "Primary care doctors I think at the end of the day are interested in things that are actionable ... A disability questionnaire says, 'this patient has an unmet treatment need,' but it doesn't help guide the decision making."

Thus the intent of the M-TOQ is to elicit more specific information that a clinician can use to make a specific treatment decision, he said. "The patient may come back, and the patient might say 'Better.' And you might not realize they have a problem. Or they may say, 'I'm not doing that well.' And that doesn't give you the information you need to take the next step to optimize treatment," he explained. "So when the patient says 'My medicine isn't working,' you need to know: Is the problem side effects? Is the problem recurrence? Is the problem lack of restoration of function?" He noted that the M-TOQ questions are freely available for clinicians to use in their practice.

A forthcoming study will assess the use of the M-TOQ on patient outcomes, Dr. Lipton said.

The study was supported by Pfizer Inc.

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