Patients' Values and Preferences Regarding Pharmacologic Treatments for the Prevention of Episodic Migraine Headache: A Systematic Review for the American College of Physicians

Background: Decision making regarding pharmacologic treatments for the prevention of episodic migraine may depend on the importance that patients place on outcomes and specific treatment preferences. Purpose: To assess patients’ values and preferences regarding pharmacologic treatments for the prevention of episodic migraine. Data Sources: MEDLINE and CINAHL from inception to April 2024. Study Selection: Quantitative studies reporting on values and preferences regarding pharmacologic treatments for the prevention of migraine in adults were eligible. Data Extraction: We extracted data on study design, participants, and findings and assessed risk of bias using a tool developed by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) working group. Data Synthesis: We included 6 studies (5 discrete choice experiments and 1 survey) comprising a total of 2307 participants and assessing the importance of a total of 32 attributes. Risk of bias was moderate in 3 and low in 3 studies; all but 1 were industry spon sored. Migraine severity, frequency, and duration were found to be the most important among several outcomes including acute medication need and side effects (low certainty). Other outcomes of importance were migraine attack on day 1 postdosing (moderate certainty) and duration of daily activity limitations (high certainty). Patients preferred oral tablets to injections and infusions (moderate certainty). Limitations: Importance of attributes relative to each other could not be assessed due to the scarcity of direct comparisons. Participant sampling was unclearly reported in most studies. Conclusion: Patients may have the strongest preference for oral treatments that reduce the severity, frequency, and duration of their migraine attacks, which reduce the duration of daily activity limitations and reduce risk of migraine on day 1. Side effects may be less important.