Nancy C. Santanello

Determinants of patient satisfaction with migraine therapy

Determinants of patient satisfaction with migraine treatment are not well understood. The objective of this study was to evaluate which treatment outcomes influence patient satisfaction with treatment. Analyses were performed on data from 1506 migraineurs from two clinical trials of rizatriptan for treatment of migraine. Satisfaction with treatment was assessed 2 h after initial treatment and prior to use of rescue therapy. Over 90% of patients who were pain-free at 2 h were at least somewhat satisfied with treatment compared with < 10% of patients with moderate or severe pain. Only 60–70% of patients with mild pain at 2 h experienced some level of satisfaction with treatment. For patients with mild pain at 2 h, results showed subjects who reported severe pain at baseline, absence of associated symptoms at 2 h and pain relief within the first 90 min had at least a 76% probability of being at least somewhat satisfied. This probability decreased with the presence of associated symptoms, slower pain relief and moderate baseline pain intensity. Fast, complete pain relief is one important factor in determining short-term patient satisfaction with treatment.

Development of a brief 24-hour migraine-specific quality of life questionnaire.

The objective of this study was to develop a questionnaire to assess the short‐term quality of life decrements associated with an acute migraine headache attack. A total of 101 potential quality of life items were generated by interviewing migraineurs and migraine specialists and reviewing the literature. To reduce the items, 76 migraineurs (18 years and older) were asked to identify which of the 101 items affected their quality of life in the 24 hours following onset of a migraine and to rate them on a five‐point scale from “not very important” to “extremely important.” Reduction of the 101 items to a 15‐item questionnaire was performed by evaluating the results of subject‐perceived importance (number of times an item was chosen x mean importance score) in combination with principal components analysis. Five domains were identified: (1) work functioning, (2) social functioning, (3) energy/ vitality, (4) migraine headache symptoms, and (5) feelings and concerns. Each domain has three items and the correlation between the five domains, as measured by the Spearman correlation coefficient, ranged from 0.08 to 0.38 suggesting minimal overlap. The brief migraine quality of life questionnaire was pilot‐tested in two groups of 10 migraineurs and revised to improve clarity.

Determinants of migraine-specific quality of life

This paper reports an analysis of two randomized controlled trials of rizatriptan, in which the 24-h Migraine Quality of Life Questionnaire© was used to assess migraine-specific quality of life in patients receiving acute treatment. The objective of the analysis was to determine which clinical effects of a migraine medication, as measured by traditional clinical trial endpoints, contribute to a better short-term health-related quality of life. The results demonstrate that patients who experience complete pain relief and are able to function at their normal ability within 2 h and experience no headache recurrence have the highest migraine-specific quality of life scores. Patients who were satisfied with medication at 2 h had higher migraine-specific quality of life scores than those who were not satisfied. In conclusion, migraine therapy that provides rapid, complete, and sustained pain relief, with restoration of functional ability, has the most beneficial impact on short-term health-related quality of life for migraineurs.

Development of a Brief 24-Hour Adolescent Migraine Functioning Questionnaire

The objective was to develop a brief questionnaire to assess short‐term functioning decrements in adolescents with acute migraine. One hundred twenty‐three potential items were generated by literature review and by interviewing adolescent migraineurs and migraine specialists. To reduce the items, 127 adolescents were asked to identify which items affected their daily functioning in the 24 hours following onset of a migraine, and to rate them on a 5‐point scale from “not very important” to “extremely important.” Reduction to an 18‐item questionnaire was performed by evaluating subject‐perceived importance (number of times an item was chosen times mean importance score) in combination with principal components factor analysis. Five domains were identified: (1) activities, (2) social functioning, (3) cognitive functioning, (4) migraine headache symptoms, and (5) emotional functioning. Questions regarding school loss and school performance during a migraine were added to the final questionnaire as a separate outcome measure. The correlation between the five domains as measured by the Spearman correlation coefficient ranged from 0.17 to 0.49 suggesting some, but minimal, overlap. Cronbach alpha for individual domains ranged from .50 to .84. The questionnaire was pilot‐tested in 12 adolescent migraineurs to determine ease of administration and comprehension and revised to improve clarity.

A reply to Dr Steiner

Is the quality of life of a prisoner serving 10 years the same on the first day of his sentence as on the last? . Symptoms of migraine impose a burden on sufferers frOUl this condition. Headache, nausea l!UtI vomiting, hypersensitivity syndromes, a..1.d debility all add to the migraineurs disease-induced suffering, For their duration, these symptoms are likely to spoil functioning, activities and, it may be said, pleasure in life. hat has any of this to do with qualibJ of ltie? Migraine symptoms occurring frequently, unpredictably, and Perhaps with ~poor response to treatment, have the potential to induce anxiety, foreboding, dread of retunrlng illness, and consequent unwillingness to !!.. li-.e plans betr.!Jeen att.ac)r..s. In this chronic situation, functioning, activities, and pleasure in life are impaired. for-the foreseeable future. The fundamental of lift is its continuity. Lasting from birt.h to death, in normal lay langu..ge life can nonetheless be spoken of in shorter periods without loss of that essence. But the notion that it exists in aliquots of one day (1) is manifestly