OBJECTIVES: Anti-CGRP monoclonal antibodies and onabotulinumtoxinA have demonstrated efficacy and tolerability, the two most important migraine treatment attributes. This study assessed the relative importance of other attributes in the choice of preventive migraine treatment from the patient perspective.

METHODS: This non-interventional, cross-sectional study enrolled US adults with self-reported migraine diagnoses, who experienced ≥5 monthly migraine days, and had tried ≥2 prescription migraine treatments. A 25-minute discrete choice online survey was used to assess treatment preferences by having respondents select between two profiles that varied in attributes: speed of onset (24hr, 1wk, or 3mo), durability of prevention (wears off 1wk prior to next dose, 2wks prior to next dose, or does not wear off), mode of administration (IV, self-injection, or cranial injections), administration setting (at-home or in-office), and dosing frequency (1mo or 3mo). Hierarchical Bayes modeling estimated attribute-level preference weights. A latent class analysis identified subgroups that differed in their preferences.

RESULTS: 604 patients were analyzed. Mode of administration, durability of prevention, and speed of onset had the highest relative importance; administration setting and frequency of dosing had the lowest. Four groups with differing preferences were identified: those preferring auto-injection (n=128, 21%); those averse to cranial injections (n=189, 31%); those preferring faster speed of onset (n=158, 26%); and those preferring longer durability and clinicians to administer treatment (n=129, 21%). Except for those preferring auto-injection, all groups were willing to accept IV administration to achieve other treatment goals, indicating that three-fourths of participants were not averse to IV infusion as a route of administration.

CONCLUSIONS: Among people living with migraine who have ≥5 monthly migraine days, important attributes of preventive migraine treatment were mode of administration, durability of effect, and speed of onset. Infusion as a route of administration was not considered a barrier for most patients.