Evaluating Migraineurs' Preferences for Migraine Treatment Outcomes Using a Choice Experiment

• Published in: Headache Vol. 53; no. 10; pp. 1635 - 1650
• Main Authors: Gonzalez, Juan M., Johnson, F. Reed, Runken, Michael C., Poulos, Christine M.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.11.2013; Wiley Subscription Services, Inc
• Subjects: Adult; Choice Behavior; conjoint analysis; Consumers; Data Collection - methods; Female; Headaches; Humans; ictal burden; interictal burden; Male; Middle Aged; migraine; Migraine Disorders - psychology; Migraine Disorders - therapy; Patient Preference - psychology; patient preferences; productivity; Quality of life; Treatment Outcome; ictal burden; migraine; productivity; interictal burden; conjoint analysis; patient preferences
• ISSN: 0017-8748; 1526-4610; 1526-4610
• DOI: 10.1111/head.12142

Objective The impact of migraines on patients is commonly divided between the level of impairment associated with headache symptoms (headache phase) and the quality‐of‐life effects immediately following the headache (post‐headache phase). Evaluations of migraineurs' productivity losses and health‐related quality of life have provided an understanding of the burden associated with the headache and post‐headache symptoms, but do not quantify the relative importance of each phase from a patient perspective. In this study, we evaluated migraineurs' willingness to accept trade‐offs among symptom severity in the headache and post‐headache phases, symptom duration in the headache and post‐headache phases, and symptom‐free time within a general‐preference theoretic framework. Methods We administered a choice‐format, conjoint‐analysis survey, also called a discrete‐choice experiment, to a sample of migraineurs from a nationally representative online consumer panel. After inclusion and exclusion criteria were applied, 510 eligible subjects completed the survey. The survey elicited choices between pairs of migraine profiles describing symptom durations and symptom‐free time for the headache and post‐headache phase. Results Migraineurs in our study were strongly affected by the pain associated with the headache phase. However, experiencing difficulty with daily social and family activities in the post‐headache phase also had a statistically significant impact on migraineurs' perceived level of well‐being. Migraineurs reported that hypothetical treatments that limited the duration of headache symptoms without allowing them to resume their daily activities for 16 hours after a headache, on average, were less than half as good as treatments that limited both headache and post‐headache symptoms. Conclusion Our results suggest that treatments that relieve and shorten symptoms during the post‐headache phase can offer significant benefits to migraineurs.