Perceived comfort with migraine treatments and control of migraine symptoms: Results from the Headache Assessment via Digital Platform in United States study

OBJECTIVE: This study was conducted to identify patient characteristics and medication factors associated with perceived comfort with migraine treatments and control of migraine symptoms. BACKGROUND: Patient 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. METHODS: Participants 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 between September and November 2023. Comfort and control were defined using corresponding items from the Migraine Treatment Optimization Questionnaire and categorized as "high" or "low." We compared patient characteristics, clinical features, and medication classes by reported comfort and control. RESULTS: Among 5717 participants (mean age, 41.7 ± 13.0 years; 92.1% female), 58.5% reported high comfort with migraine treatments, whereas 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 Migraine Symptom Severity Score 18 vs. 19; p < 0.001), and lower disability (Migraine Disability Assessment Score, severe: 72.7% vs. 91.2%; p < 0.001) and mood symptom scores (Patient Health Questionnaire-4 severe: 9.5% vs. 21.0%; p < 0.001), as well as income, education, and employment status. High perceived control showed similar associations with monthly headache days (mean, 9.0 vs. 12.7; p < 0.001), migraine severity (median Migraine Symptom Severity Score, 18 vs. 19; p < 0.001), disability (severe: 66.0 vs. 85.8; p < 0.001), and mood symptoms (severe: 7.6 vs. 16.9; p < 0.001), and was associated with employment status but not income or education. Among those on monotherapy, gepants and triptans were associated with higher comfort and efficacy than over the counter medications or opioids/barbiturates/ergots. For preventive therapy, β blockers and botulinum toxin were associated with the lowest perceived comfort and efficacy. CONCLUSION: Perceived 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.