Migraine is a neurological condition that affects approxi-
mately 12% of patients in the United States and
millions worldwide.1
Women are affected dispropor-
tionally, with a 3-fold higher prevalence of migraine disorder.
Prevalence peaks between age 25 and 55 years, affecting the
most productive years of a person’s life.2
Patients experience
varying levels of frequency, severity, and disability associated
with migraine. More frequent and severe cases with significant
impact on patients’ quality of life and daily activities may ben-
efit from headache prophylaxis. Existing prophylaxis therapies
include a variety of options (e.g., beta blockers, antidepressants,
anticonvulsants, onabotulinumtoxinA). At the time of this
study, guidelines, such as those published by the U.S. Headache
Consortium, recommended first-line prophylaxis with pro-
pranolol, timolol, amitriptyline, or divalproex.3
Although some
patients see relief from these therapies, unfavorable side effects
may limit tolerability and thus impact the effectiveness of pro-
phylaxis. Ultimately, patient tolerance is a crucial component
for the success of migraine prophylaxis. A study that explored
the extent to which migraine patients are willing to tolerate
side effects of prophylaxis found that the top reasons why a
prophylactic is deemed intolerable to patients are weight gain,
memory loss, depression, and somnolence.4
These findings can
be readily applied to migraine prophylaxis, where possible side
effects include cognitive effects (topiramate), somnolence (ami-
triptyline and propranolol), and weight gain (divalproex).
Adherence refers to the extent to which a patient follows pre-
scribed directions with respect to timing, dose, and frequency.5
Adherence to chronic therapy is a common issue across many
disease states. Poor adherence (