Perceived comfort with migraine treatments and control of migraine symptoms: results from the HEAD-US study

ObjectiveTo identify patient characteristics and medication factors associated with perceived comfort with migraine treatments and control of migraine symptoms. BackgroundPatient perceptions of migraine treatment influence adherence and outcomes, yet little is known about their underlying drivers. Our study objective was to identify clinical features of migraine associated with comfort and perceived control of symptoms, and medication classes associated with higher patient comfort and efficacy. MethodsParticipants in the Headache Assessment via Digital Platform in United States (HeAD-US) study completed a cross-sectional survey on demographics, migraine burden, mood, disability, and medication use. Comfort and control were defined using corresponding items from the Migraine Treatment Optimization Questionnaire (mTOQ-6) and categorized as "high" or "low". We compared patient characteristics, clinical features, and medication classes by reported comfort and control. ResultsAmong 5717 participants (mean age 41.5 {+/-} 13.1 years, 91.2% female), 58.5% reported high comfort with migraine treatments, while only 27.5% reported high control of migraine symptoms. High comfort was associated with fewer monthly headache days (mean 9.9 vs. 14.2, p<0.001), lower migraine symptom severity (median MSSS 18 vs. 19, p<0.001), and lower disability (MIDAS severe: 72.7% vs 91.2%, p<0.001) and mood symptom scores (PHQ-4 severe: 9.5% vs. 21.0%, p<0.001). High perceived control showed similar associations with employment (OR=1.25, CI 1.15-1.48, p = 0.013), monthly headache days (mean 9.0 vs 12.7,p<0.001), migraine severity (median MSSS 18 vs 19, p<0.0001), disability (severe: 66.0 vs 85.8, p<0.001), and mood symptoms (severe: 7.6 vs 16.9, p<0.001) but was not associated with income or education. Among those on monotherapy, gepants and triptans were associated with higher comfort and efficacy than OTC medications or opioids/barbiturates. For preventive therapy, beta blockers and botulinum toxin were associated with the lowest perceived comfort and efficacy. ConclusionPerceived comfort and control were linked to headache frequency, severity and disability and mood symptoms. Medication class use influenced perceptions, with gepants and triptans rated most favorably. These findings underscore the importance of incorporating patient perspectives into treatment planning, with particular attention to mood, disability, and choice of medication.