NONCOMPLIANCE MAY RENDER MIGRAINE PROPHYLAXIS USELESS, BUT ONCE-DAILYREGIMENS ARE BETTER

Medicines work better if taken, which must be true of migraine prophyl axis. There is evidence that compliance with regular medication can be badly deficient. To assess how serious the problem might be in routin e migraine management, we undertook a covert observational 2-month sur vey in a specialist headache clinic using objective measures of compli ance. Subjects were 38 patients needing prophylaxis with medication pr escribed once (ed), twice (bd), or three times daily (tds). Medication was dispensed, unknown to them, in Medication Event Monitoring System s (MEMS) to record openings in real time. Number, timing, and pattern of actual openings were compared with what was expected. Compliance ra tes averaged 66%, although returned pill counts indicated 91%. A subst antial and significant difference was shown between od and bd or tds r egimens. Measures of dosing interval-used-on-schedule rate and therape utic coverage-averaged between 44% and 71%. Once-daily treatment was a ssociated with a used-on-schedule rate more than double those of multi ple daily dosing, but still only 66%. We conclude that routine use of drug prophylaxis in migraine may be so seriously undermined by poor co mpliance that it has little chance of efficacy. Returned-pill counting is inadequate for compliance assessment.