Acute treatment optimization in episodic and chronic migraine: Results of the American migraine prevalence and prevention (AMPP) study

Daniel Serrano, Dawn C. Buse, Aubrey Manack Adams, Michael L. Reed, Richard B. Lipton

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


Background The migraine Treatment Optimization Questionnaire (mTOQ) was developed to assess response to acute treatment in persons with migraine. The original validated form used yes or no response options. Objectives This study aims to (1) assess the psychometric properties of a 6-item version of the mTOQ (mTOQ-6) using ordinal response options; (2) compare treatment optimization using the revised mTOQ-6 for both episodic and chronic migraine (EM and CM, respectively); (3) identify demographic, headache, and treatment features associated with treatment optimization. Methods The American Migraine Prevalence and Prevention (AMPP) Study is a longitudinal, US population-based study. Annual questionnaires were mailed to a sample of 24,000 severe headache sufferers identified by screening a panel constructed to be representative of the US population. The current study included respondents to the 2006 AMPP Study survey who met modified International Classification of Headache Disorders-3 beta criteria for migraine; persons with CM (≥15 HA days/month) or EM (<15 HA days/month) were included. Acute treatment optimization was measured with the mTOQ-6. A single factor latent variable model was used to assess item characteristics. This model was expanded through structural equation models (SEM) to incorporate a contrast between persons with CM and EM on the scaled treatment optimization scores. We estimated both an unadjusted SEM and a SEM adjusted for demographic features, headache characteristics, and acute treatment. Results Migraine criteria were met by 8612 persons (539 for CM and 8073 for EM) who completed the mTOQ-6 as part of the 2006 AMPP Study survey. When compared, those with CM exhibited worse treatment optimization across all domains of the mTOQ-6. For example, 35.1% of CM and 44.6% of EM respondents reported being pain free at 2 hours "half the time or more" with their usual migraine medication. Latent variable model parameters indicated excellent psychometric properties of the mTOQ-6. Scaled treatment optimization scores obtained from the unadjusted SEM were significantly lower (indicating worse treatment optimization) for persons with CM (3.25) compared to persons with EM (4.01), b = -0.76, P < .0001; scores remained significantly lower for CM after adjustment with a wide array of demographic and disease severity covariates. Poor treatment optimization was associated with cutaneous allodynia, major depression, and the use of nonsteroidal anti-inflammatory drugs. Better treatment optimization was associated with the use of triptans and preventive medications. Conclusion Estimates of the latent variable scores for the mTOQ-6 revealed persistent low levels of treatment optimization for both EM and CM, though treatment optimization is worse for CM.

Original languageEnglish (US)
Pages (from-to)502-518
Number of pages17
Issue number4
StatePublished - Apr 1 2015


  • acute treatment
  • chronic migraine
  • episodic migraine
  • migraine
  • outcome
  • treatment optimization

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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