The story was also silent about costs, did not include an independent perspective, and pulled a quote from a press release from the American Academy of Neurology. Had it covered the topic more thoroughly, this story would probably have been less confused as to why so many patients choose not to prevent headaches merely “by swallowing a few pills.” The issue is far more complex than that.
Migraine headaches can be debilitating and can last from hours to days per episode. Although a great deal of emphasis has been placed on their treatment, prevention has been a poor stepchild. Only about a third of people who suffer from migraines have frequent enough or severe enough episodes to warrant the risks associated with preventive treatments. But as we know from the article in Neurology, only a small minority of those who could benefit actually do so. The reasons are likely multiple and include a lack of understanding on the part of the patient or caregiver, economics or side effects to name a few.
The cost of migraine prevention drugs was not mentioned and cost is an important consideration. The costs range from pennies a day for beta blockers to over $300 for a monthly regimen of Trova. Even the guideline authors mentioned cost as a potential barrier.
Here’s what the story states: “Neurologists estimate that about 38% of people who suffer from migraines stand to benefit with such a regimen, and studies suggest that as many as half of migraines can be prevented with drugs.”
Thanks to the competing USA Today coverage, we know that this is an overly optimistic assessment, since in that story it was noted that patients may need to try 3 or 4 different drugs, alternative therapies, and lifestyle changes to achieve a 50% reduction in headaches.
Although the story was not specific enough on this point, it reminded readers that all drugs “can have side effects or interact with other medications.” It didn’t mention how serious they might be or how often they might occur. We’ll give the story the benefit of the doubt however since the list of drugs is long and the incidence and severity of the side effects is complicated
There is no discussion of how these ratings were developed. There is also no mention of limitations of the studies that formed the basis for the guidelines. The guidelines themselves note, for example, that migraine prevention studies were usually of short duration (often only 12–16 weeks), and so the long-term efficacy of these therapies is uncertain.
The story noted that 5 of the 6 guideline authors disclosed relationships with drug companies. However, the only source quoted in the article is one of the guideline authors — no independent perspective was included.
Unlike the USA Today story we reviewed, non-drug approaches were not mentioned. Despite the fact that the story was based on a set of guidelines for drug treatments, we would have liked to have seen a few words on non-pharmacologic approaches including stress reduction, diet, etc.
It’s clear from the story that these drugs are widely available.
The story did not oversell the novelty of these drugs.
We can’t be sure of the extent to which the story relied on a news release. We do know:
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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