S20 Supplement 2, 1999 From the Departments of Neurology, Epidemiology, and Social Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY and Innovative Medical Research, Stamford, Conn and Towson, Md (Dr. Lipton); the Department of Epidemiology, The Johns Hopkins University, Baltimore, Md and Innovative Medical Research, Stamford, Conn and Towson, Md (Dr. Stewart). Address all correspondence to Dr. Richard B. Lipton, Innovative Medical Research, 1200 High Ridge Road, Stamford, CT 06905. Acute Migraine Therapy: Do Doctors Understand What Patients With Migraine Want From Therapy? Richard B. Lipton, MD, Walter F. Stewart, PhD, MPH With a better and more diverse armamentarium than ever before, physicians can now select migraine therapy to satisfy the preferences of migraine sufferers, provided physicians understand what migraineurs want from therapy.To determine patient preferences and priorities, individuals with migraine were identified by a random- digit telephone survey during 1998.These individuals were polled regarding their consultation practices, treatment preferences and priorities, and factors affecting their satisfaction with migraine care. At a subsequent satellite symposium at a meeting of the American Association for the Study of Headache (AASH), attendees were asked to predict the responses of migraine sufferers; responses of migraine sufferers and health care professionals attend- ing the meeting were then compared. Of the 688 migraine sufferers identified in the telephone survey, 46.7% cur- rently consulted physicians regarding migraine, while 20.6% had consulted at some time but not during the past year, and 32.3% had never consulted a physician regarding migraine.While most (77%) patients were satisfied or very satisfied with current medications, those who were not completely satisfied complained that pain relief took too long (87%), was inconsistent (84%), or that the pain recurred (71%). Only 35% complained of side effects. The three most important attributes of a migraine medication (according to migraine sufferers) were complete relief of pain (87%), lack of recurrence (86%), and rapid onset of pain relief (83%).The majority of migraine sufferers pre- ferred an oral tablet or capsule as a first-choice route of administration (73%) and an oral, rapidly dissolving tablet as a second-choice route (51%). Attendees of the AASH meeting closely anticipated these patient responses about medications. The physician attribute most highly valued by patients was willingness to answer questions (86%), which was not anticipated by AASH attendees. Key words: migraine, treatment attributes, patient preferences, epidemiology, telephone survey, route of administration, physician attributes (Headache 1999;39[suppl 2]:S20-S26) The expanding therapeutic armamentarium for migraine provides an unprecedented range of treatment choices both for doctors and for patients. 1 As therapeutic options become more diverse, it becomes more important to understand patients’ attitudes and preferences regarding various treatment characteristics. Selecting among treat- ments requires an evaluation of efficacy and safety; opti- mizing treatment also requires an assessment of how well alternative treatments meet patient needs and expectations for rapid relief of pain, completeness of pain relief, lack of side effects, low recurrence rate, ease of administration, etc. Failure to understand patient preferences may reduce adherence and discourage patients from continuing treat- ment. A thorough understanding of an individual patient’s expectations for migraine treatments will help physicians match treatments to their patients’ needs. This should improve the chances for successful migraine manage- ment. From a societal perspective, patient expectations should be considered early in the drug development process to ensure that medications selected for develop- ment meet treatment needs. Despite the extensive data on epidemiology and