{"paper_id":"4029b9a2-a0df-4753-a42d-4bfd5bcd5a1c","body_text":"Real-World Assessment of Current Migraine Prophylaxis in Egypt: A Multicenter National Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Real-World Assessment of Current Migraine Prophylaxis in Egypt: A Multicenter National Study Salsabil Abo Al-Azayem, Mona AF Nada, Ahmed Dahshan, Mona K Moawad This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7480734/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 08 Jan, 2026 Read the published version in The Journal of Headache and Pain → Version 1 posted 9 You are reading this latest preprint version Abstract Background & objectives Prophylactic treatment plays a crucial role in reducing the frequency, severity, and duration of migraine attacks. This study, the first to address this issue in Egypt, aimed to study the patterns of prophylactic treatment utilization among migraine patients and assess adherence to prescribed regimens. Methods A cross-sectional study was conducted on 200 migraine patients. Headache was assessed as follows: type of migraine, duration of attacks, frequency of headache per month, disability using the Migraine Disability Assessment Scale (MIDAS) and headache severity using a visual analog scale (VAS), and treatment history. Prophylactic treatments were evaluated regarding type, dose, adherence using Adherence to Refills and Medications Scale (ARMS) and efficacy using monthly migraine days (MMD) as well as adherence predictors were assessed. Results In our cohort, the median age was 32 years, with women comprising 70.6% of the cohort. For abortive treatment, paracetamol was the most prescribed medication (42%). Regarding prophylactic treatment, 83.3% of patients received monotherapy, with antiepileptic drugs being the most prescribed (40%). Notably, polytherapy regimens demonstrated statistically significant superiority in reducing headache duration, MMD, VAS scores, and MIDAS scores (P < 0.001). However, adherence to prophylactic treatment was low, with only 30.4% of patients maintaining adherence. Multivariate regression analysis identified the use of antidepressants as an independent predictor of adherence. Conclusion Non-adherence to prophylactic medication is prevalent among migraine patients in Egypt. The severity of migraine attacks is lower in patients receiving polytherapy regimens; however, using antidepressants is associated with treatment adherence. Migraine Prophylactic treatment of migraine Adherence to treatment MIDAS ARMS Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Background Migraine is a prevalent and debilitating neurological disorder that poses challenges not only in its management but also in its prevention [ 1 ]. While acute treatment options aim to alleviate symptoms during migraine attacks, prophylactic treatment plays a crucial role in reducing the frequency, severity, and duration of these episodes [ 2 ]. Despite the proven efficacy of prophylactic therapies, adherence to these treatments remains a persistent challenge. A growing body of evidence highlights that non-adherence is a major barrier to achieving optimal outcomes in migraine care. Factors such as side effects, complex regimens, and individual barriers related to socioeconomic or cultural contexts contribute to this issue [ 3 ]. However, the literature is sparse regarding region-specific factors influencing adherence, particularly in low- and middle-income countries (LMIC) such as Egypt. Research has examined the use of migraine prophylactic medications among individuals enrolled in medical plans. These studies often rely on pharmaceutical records to provide more accurate data on medication usage; however, they are limited by challenges in accurately identifying all individuals with migraine [ 4 ]. Meyers et al. [ 5 ] highlight the scarcity of real-world data on migraine epidemiology and current treatment approaches, emphasizing the need for such information. Although prophylactic medications for migraine have been available for many years, studies assessing their real-world efficacy and tolerability remain limited [ 6 ]. To address these gaps, this study aims to provide a comprehensive assessment of prophylactic treatment utilization and adherence among individuals diagnosed with migraine in Egypt. In a recently published study, it was found that the prevalence of migraine in Egypt is 20% which means that almost 22 million people in Egypt suffer from migraine [ 7 ]. That is way, for the first time in this region, the research will examine adherence levels, identify key barriers, and explore the relationship between adherence and treatment outcomes. By shedding light on the determinants of adherence, this study seeks to inform patient education initiatives, tailor treatment strategies to the local population, and develop interventions to enhance adherence, optimizing the management of this debilitating condition. Methods Study population This cross-sectional study screened 1100 patients presenting with headache and included 200 patients aged 14–65 who met the International Classification of Headache Disorders, third edition (ICHD-3) criteria for migraine [ 8 ] and agreed to participate. The patients were recruited from two headache centers in Egypt representing the 2 larger governates: Cairo University Hospital (A tertiary center) and a private headache center in Alexandria, between June 2023 and April 2024. To minimize potential bias, the referring neurologists were blinded to the study's goals, ensuring that patient referrals were based solely on clinical indications rather than study-related factors. Patients were excluded if they met any of the following criteria: 1. Diagnosed with headaches other than migraine.2. Exhibited focal neurological deficits. 3. Had other neurological diseases. Data Collection: Demographic and clinical data were collected through face-to-face interviews. The data gathered included: Age at onset, Disease duration, Type of migraine (with or without aura), Type of aura (if present), Duration of attacks (in hours), Frequency of headaches per month using monthly migraine days (MMD). Treatment history: During the interview, patients' medication histories, including both prophylactic and abortive treatments, were collected. Prophylactic treatment was defined as any specific or non-specific treatment to prevent migraines [ 3 ]. Prophylactic medication details were documented, including: 1. Type of medication, 2. Dose, 3. Duration of use (in months), 4. Frequency of administration per day, 5. The number of prophylactic treatments used included single drug or polytherapy which is defined as two or more drugs used, 6. Reported side effects, 7. Prescribing physician’s specialty, 8. Adherence to treatment and 9. Efficacy of prophylactic medication Adherence to prophylactic treatment: Adherence to prophylactic treatment was defined as the extent to which patients follow their prescribed therapy over a fixed period [ 9 ]. Adherence was measured using the 12-item Arabic version of the Adherence to Refills and Medications Scale (ARMS) , with a score of ≥ 16 used as the threshold for non-adherence and < 16 for adherence [ 10 ]. ARMS is a self-reported scale developed in English, consisting of two subscales: adherence to filling prescriptions and medication adherence [ 11 ]. Headache-related disability: The Migraine Disability Assessment Scale (MIDAS) (Arabic version) [ 12 ] was used to assess the impact of migraines on daily activities before and after prophylactic treatment. MIDAS consists of five questions that evaluate the effect of headaches on three activity categories over the previous three months: Paid work (days off work and reduced efficiency), Household activities (days affected by headaches) and Recreational, social, and family events (missed days due to headaches) [ 13 ]. The total MIDAS score was calculated by adding the scores for each of the five questions. Headache Severity Headache severity was assessed using the Visual Analogue Scale (VAS) before and after prophylactic treatment. Statistical analysis Data were coded and maintained with the Statistical Package for the Social Sciences (SPSS) version 28 (IBM Corp., Armonk, NY, USA). Quantitative data was summarised using mean, standard deviation, median, minimum, and maximum, while categorical data was summarised using frequency (count) and relative frequency (%). The quantitative variables were compared using the non-parametric Kruskal-Wallis and Mann-Whitney tests. To compare serial measurements within each patient, the non-parametric Wilcoxon signed rank test was applied [ 14 ]. To compare categorical data, the Chi-square (χ²) test was used. An exact test is utilised when the anticipated frequency is fewer than five [ 15 ]. Non-parametrical methods were used as data deviated from the normal distribution, as noted by double-checking normality using normality tests and plots. Logistic regression was used to identify independent determinants of adherence [ 16 ]. P-values of less than 0.05 were considered statistically significant. In our study, we used Jointpoint regression analysis to identify significant changes in trends within the data. The breakpoints were determined using a permutation test with a Monte Carlo stimulation approach to assess statistical significance. The Bayesian Information Criterion (BIC) and Goodness-of-Fit Statistics were used to select the optimal number of breakpoints, ensuring that the model balances complexity and explanatory power. Results The baseline characteristics of the study population are displayed in table 1. The median patient age was 32 years, and females accounted for 70.6% of the cohort. The median duration of disease was 16.5 months. Tables (1) Demographics, clinical characteristics of migraine patients Item Count Age in years [median (IQR)] 32 (14–63) Gender [n (%)] Male 30 (29.4%) Female 72 (70.6%) Education in years [median (IQR)] 16 (6–25) Marital status [n (%)] Single 32 (31.4%) Married 65 (63.7%) Divorced 5 (4.9%) Employment status [n (%)] Unemployed 49 (48.0%) Employed 53 (52.0%) Comorbidities [n (%)] Yes 29 (28.4%) No 73 (71.6%) Specify comorbidity/s [n (%)] Medical comorbidites 18 (62.1%) Psychiatric 11 (37.9%) Health insurance [n (%)] Yes 45 (44.1%) No 57 (55.9%) Age at onset of migraine in years [median (IQR)] 18 (8–33) Type of migraine [n (%)] Episodic 54 (52.9%) Chronic 48 (47.1%) Aura [n (%)] Yes 31 (30.4%) No 71 (69.6%) Type of aura [n (%)] Visual 22 (71.0%) Sensory 9 (29.0%) Of the 200 patients included in our study, 102 (51%) required prophylactic migraine treatment and were started on an appropriate regimen. The remaining 98 patients (49%) did not receive prophylactic therapy, either because it was not clinically indicated (40 patients) or because they declined treatment after discussing its potential benefits (58 patients), often citing prior negative experiences with prophylactic treatments or information obtained from social media. This finding highlights a gap in adherence and willingness to initiate therapy among eligible patients (Fig. 1 ). The types of treatments (abortive or prophylactic) used in this cohort are presented in table 2. Regarding prophylactic treatment, most of the patients (83.3%) received monotherapy; topiramate was the most prescribed prophylactic medication as monotherapy (25.49%). Antiepileptic drugs (AEDs) were used more in episodic migraine patients, while polytherapy was more common in chronic migraine (CM) patients (P-value = 0.02) (Table 2). Tables (2) Types of migraine treatment used Item Total Episodic migraine Chronic migraine P value Acute treatment [n (%)] Paracetamol 42 (41.2%) 27 (50%) 15 (31.3%) < 0.001 NSAID 23 (22.5%) 17 (31.5%) 6 (12.5%) Triptan 29 (28.4%) 9 (16.7%) 20 (41.7%) Polytherapy 8 (7.8%) 1 (1.9%) 7 (14.6%) Prophylactic treatment [n (%)] BB 17 (16.7%) 11 (20.4%) 6 (12.5%) 0.022 CCB 1 (1.0%) 1 (1.9%) 0 (0.0%) AED 40 (39.2%) 27 (50%) 13 (27.1%) Antidepressant 17 (16.7%) 7 (13.0%) 10 (20.8%) Anti-CGRP 6 (5.9%) 2 (3.7%) 4 (8.3%) Botox 3 (2.9%) 1 (1.9%) 2 (4.2%) ARB 1 (1.0%) 1 (1.9%) 0 (0.0%) Polytherapy 17 (16.7%) 4 (7.4%) 13 (27.1%) NSAID: nonsteroidal anti-inflammatory drugs, BB: betablocker, CCB: calcium channel blocker, AED: antiepileptic drugs, Anti-CGRP: calcitonin gene related peptide monoclonal antibodies ARBs: angiotensin receptor blockers. P-value > 0.05 is considered non-significant Regarding acute treatment, paracetamol was the most commonly prescribed medication, used by 42% of patients. Nonsteroidal anti-inflammatory drugs (NSAIDs) were more frequently used in episodic migraine compared to chronic migraine, whereas triptans and combination therapy were more commonly utilized among chronic migraine patients (p < 0.001) (Table 2). Following prophylactic treatment, migraine patients demonstrated a significant reduction in attack duration, MMD, VAS scores, and MIDAS scores compared with baseline (p < 0.001) (Table 3) where polytherapy regimens followed by antiepileptic drugs (AEDs) were associated with significant reductions the above-mentioned parameters (p < 0.001) (Table 4 & Fig. 2 – 5 ). Tables (3) Comparison between headache characterstics before and after treatment prophylactic treatments Mean Standard Deviation Median Minimum Maximum P value Mean duration of attacks (in hours) before ttt 20.86 23.03 9.50 2.00 72.00 < 0.001 Mean duration of attacks (in hours) After ttt 4.48 2.27 4.00 1.00 12.00 Frequency of headaches (monthly migraine days, MMD) before ttt 14.36 7.07 12.00 2.00 30.00 < 0.001 Frequency of headaches (monthly migraine days, MMD) after ttt 8.18 5.94 8.50 1.00 22.00 VAS (before ttt) 8.27 1.38 9.00 5.00 10.00 < 0.001 VAS (after ttt) 4.75 2.24 5.00 1.00 9.00 MIDAS Score (before ttt) 18.09 8.14 20.00 4.00 68.00 < 0.001 MIDAS Score after treatment 7.57 5.16 8.00 0.00 24.00 MMD:monthly migraine days, VAS: visual analogue scale, MIDAS: Migraine Disability Assessment Scale P-value > 0.05 is considered non-significant Tables (4) Prophylactic treatment and characheristic headache in migraine patients current medication BB AED Antidepressant Anti-CGRP poly P value Change in Mean duration of attacks (in hours) Mean -3.41 -21.75 -3.41 -1.33 -39.24 < 0.001 SD 10.28 24.04 10.99 4.68 25.60 Median -1.00 -13.00 -1.00 -1.00 -44.00 Minimum -39.00 -70.00 -45.00 -8.00 -70.00 Maximum 5.00 3.00 3.00 6.00 -6.00 Change in Frequency of headaches (monthly migraine days, MMD) Mean -2.24 -6.20 -2.65 -2.50 -14.88 < 0.001 SD 3.44 7.72 3.35 3.62 7.22 Median -2.00 -5.00 -3.00 -4.00 -18.00 Minimum -9.00 -26.00 -8.00 -6.00 -24.00 Maximum 3.00 4.00 2.00 2.00 -3.00 Change in VAS Mean -1.35 -4.43 -1.71 -0.33 -6.53 < 0.001 Standard Deviation 1.62 2.95 1.36 1.75 1.97 Median -2.00 -5.00 -1.00 -0.50 -6.00 Minimum -4.00 -9.00 -6.00 -3.00 -9.00 Maximum 2.00 1.00 0.00 2.00 -1.00 Change in MIDAS Score Mean -0.576 -11.48 -6.82 -0.33 -20.47 < 0.001 Standard Deviation 6.91 8.08 6.55 6.62 13.37 Median -3.00 -15.00 -4.00 1.00 -18.00 Minimum -16.00 -22.00 -16.00 -12.00 -68.00 Maximum 3.00 2.00 3.00 8.00 -3.00 MMD:monthly migraine days, VAS: visual analogue scale, MIDAS: Migraine Disability Assessment Scale, BB: betablocker, AED: antiepileptic drugs, Anti-CGRP: calcitonin gene related peptide monoclonal antibodies . P-value > 0.05 is considered non-significant Adherence to therapy: Adherence to prophylactic treatment was analyzed at least 3 months after drug initiation. During the follow-up period, 69.6% of patients were non-adherent to prophylactic treatment, whereas only 30.4% maintained adherence. In the Adherence to Refills and Medications Scale (Arabic version), the majority of responses to questions (Q) were “none of the time” (Q3: 43.1%, Q5: 59.8%, Q7: 52%, Q8: 52%, Q9: 66.7%, Q10: 55.9%, Q11: 71.6%, Q12: 51%), followed by “some of the time” (Q1: 71.6%, Q2: 51%, Q4: 45.1%, Q6: 42.2%) (Table 5 & Fig. 6 ). Tables (5) Adherence to Refills and Medications Scale (ARMS) in our study populations None of the time Some of the time most of the times all of the time Count % Count % Count % Count % ARMS 1 22 21.6% 73 71.6% 7 6.9% 0 0.0% ARMS 2 43 42.2% 52 51.0% 6 5.9% 1 1.0% ARMS 3 44 43.1% 43 42.2% 11 10.8% 4 3.9% ARMS 4 43 42.2% 46 45.1% 13 12.7% 0 0.0% ARMS 5 61 59.8% 33 32.4% 5 4.9% 3 2.9% ARMS 6 37 36.3% 43 42.2% 13 12.7% 9 8.8% ARMS 7 53 52.0% 32 31.4% 6 5.9% 11 10.8% ARMS 8 53 52.0% 35 34.3% 9 8.8% 5 4.9% ARMS 9 68 66.7% 26 25.5% 6 5.9% 2 2.0% ARMS 10 57 55.9% 39 38.2% 6 5.9% 0 0.0% ARMS 11 73 71.6% 21 20.6% 8 7.8% 0 0.0% ARMS 12 52 51.0% 41 40.2% 9 8.8% 0 0.0% ARMS: Adherence to Refills and Medications Scale, 1. How often do you forget to take your medicine?, 2. How often do you decide not to take your medicine?, 3. How often do you forget to get prescriptions filled?, 4. How often do you run out of medicine?, 5. How often do you skip a dose of your medicine before you go to the doctor?, 6. How often do you miss taking your medicine when you feel better?, 7. How often do you miss taking your medicine when you feel sick?, 8. How often do you miss taking your medicine when you are careless?, 9. How often do you change the dose of your medicines to suit your needs (like when you take more or less pills than you’re supposed to)?, 10. How often do you forget to take your medicine when you are supposed to take it more than once a day?, 11. How often do you put off refilling your medicines because they cost too much money?, 12. How often do you plan ahead and refill your medicines before they run out? ARMS: Adherence to Refills and Medications Scale Adherent patients were more likely to be prescribed antidepressants (38.7% vs. 7% in the non-adherent group), whereas non-adherence was more frequent among those receiving antiepileptic drugs (46.5% vs. 22.6% adherent) or polytherapy (21.1% vs. 6.5% adherent) (Table 6). Tables (6) Comparison between adherent and nonadherent in patients on prophylactic treatment Adherent (n = 31) Nonadherent (n = 71) P value Age 14–29 years 10 (32%) 32 (45.1%) 0.227 30–63 years 21 (67.7%) 39 (54.9%) Gender [n (%)] Male 11 (35.5%) 19 (26.8%) 0.374 Female 20 (64.5%) 52 (73.2%) Marital status [n (%)] Single 5 (16.1%) 27 (38%) 0.059 Married 25 (80.6%) 40 (56.3%) Divorced 1 (3.2%) 4 (5.6%) Education (median (IQR)) (in years) 16 (12–20) 16 (6–25) 0.610 Employment status [n (%)] Unemployed 13 (41.9%) 36 (50.7%) 0.415 Employed 18 (58.1%) 35 (49.3%) Comorbidities[n (%)] Yes 10 (32.3%) 19 (26.8%) 0.571 No 21 (67.7%) 52 (73.2%) Health inurance[n (%)] Yes 15 (48.4%) 30 (42.3%) 0.566 No 16 (51.6%) 41 (57.7%) Age at onset of migraine [median (IQR)] (in years) 20 (12–25) 18 (8–33) 0.038* Type of migraine[n (%)] Episodic 13 (41.9%) 41 (57.7%) 0.141 Chronic 18 (58.1%) 30 (42.3%) Aura [n (%)] Yes 11 (35.5%) 20 (28.2%) 0.460 No 20 (64.5%) 51 (71.8%) Side Effect [n (%)] Yes 8 (25.8%) 30 (42.3%) 0.114 No 23 (74.2%) 41 (57.7%) MOH [n (%)] Yes 10 (32.3%) 27 (38.0%) 0.577 No 21 (67.7%) 44 (62%) Type of current medication [n (%)] BB 7 (22.6%) 10 (14.1%) < 0.001 CCB 0 (0.0%) 1 (1.4%) AED 7 (22.6%) 33 (46.5%) antidepressant 12 (38.7%) 5 (7.0%) Anti-CGRP 0 (0.0%) 6 (8.5%) botox 2 (6.5%) 1 (1.4%) ARB 1 (3.2%) 0 (0.0%) polytherapy 2 (6.5%) 15 (21.1%) BB: betablocker, CCB: calcium channel blocker, AED: antiepileptic drugs, Anti-CGRP: calcitonin gene related peptide monoclonal antibodies ARBs: angiotensin receptor blockers, MOH: medication overuse headache. P-value > 0.05 is considered non-significant Reported reasons for non-adherence included medication side effects (16.7%), perceived improvement in migraine severity and/or frequency (3.9%), cost of prophylactic treatment (2%), lack of efficacy (2%), prolonged duration of therapy (one patient), and influence from social media (one patient). Multivariate regression analysis was done to detect independent predictors of adherence. The independent variables were the use of antidepressants as prophylactic treatment (Table 7). Table (7) Logistic regression to detect independent predictors of adherence P value OR 95% C.I. Lower Upper adherence Antidepressant < 0.001 8.337 2.610 26.631 P-value > 0.05 is considered non-significant Polytherapy and Migraine Outcomes Among patients receiving prophylactic treatment, 83.3% were on monotherapy, while 16.7% were on polytherapy regimens. Patients on polytherapy showed significantly greater reductions in headache duration, MMD, VAS scores, and MIDAS scores compared to those on monotherapy (P < 0.001) (Table 4). However, adherence rates were lower among patients receiving polytherapy (6.5%) than those on monotherapy (93.5%), indicating that while polytherapy may offer enhanced clinical benefits in certain patients, it is also associated with a higher likelihood of treatment discontinuation. The most frequently used prophylactic agents in polytherapy were AEDs combined with antidepressants or beta-blockers. Discussion Migraines are a serious health and economic challenge [ 17 ]. Successful prophylactic treatment of migraine decreases disease burden, improves quality of life [ 18 ], and reduces the progression to chronic migraines [ 17 ]. However, preventative medicines are not particular to migraines because they are also used to treat depression, epilepsy, and hypertension. There has been evidence that these medications are frequently associated with low adherence to therapy, resulting in poor efficacy [ 2 ]. Therefore, it is essential to understand the current use of preventive medications in clinical practice. This represents the first Egyptian study investigating adherence patterns, clinical features and treatment patterns in migraine patients on prophylactic medications. Despite the availability of multiple prophylactic treatment options, it was estimated that nearly 12–20% of patients with migraine use prophylaxis [ 19 , 20 ], and around 38% of people with migraine could gain benefit from prophylactic treatment [ 17 , 21 ]. In the current study, 49% of patients were not on prophylactic treatment. This was due to non-indication or refusal of patients to start even after explaining the value of prophylaxis due to previous experience with other patients and/or the effect of social media. The current study confirmed that prophylactic treatment reduces attacks' frequency, duration, and severity. Migraine patients had significantly lower duration, MMD, VAS, and MIDAS scores after using prophylactic treatment. Similarly, other studies confirmed the importance of prophylactic treatment despite its underuse in real-world clinical practice [ 2 , 17 , 22 , 23 ]. The current study found that patients with migraine receiving preventive treatments had an inadequate level of adherence, with only 30.4% of patients adhering to their preventive medication. This agrees with previous research confirming the early therapeutic discontinuation trend and a low adherence rate. (26.2% in Orlando et al. [ 2 ], 37.8% Meyers et al. [ 5 ], 29% Berger et al. [ 24 ], and 29% in Hepp et al. [ 25 ]). Lafata et al. [ 4 ] showed considerably higher adherence rates in episodic migraine (EM) (56% at 12 months). One reason for the patients' non-adherence to prophylactic medication is that they had previously been prescribed prophylactic treatment but experienced no significant improvement. This was because 36% of the previous medication had been prescribed by a non-neurologist (otolaryngologist or internal medicine) who, unfortunately, prescribed non-approved AEDs for migraine prophylaxis (e.g. carbamazepine and oxcarbazepine) or the use of groups of drugs like muscle relaxants or gabapentin, or the use of approved medications but underdosed or prescribed for a short duration. Also, the lack of a clear plan and proper explanation of the expected efficacy, needed duration of treatment adherence to achieve appropriate response and possible adverse effects from prophylactic treatment by the treating physician renders the patients' adherence. Anti-calitonin gene-related peptide monoclonal antibodies (CGRP mAbs) were only used in 6 (5.9%) of our patients, 4 of which had CM, as shown in Table 2. This low number is due to the high expenses of this group of drugs, which are scarcely used in Egypt except for only a small sector of insured patients, as Egypt is one of the low-middle income countries. Moreover, the high cost of prophylactic medications presents a significant challenge, particularly for uninsured patients, who may struggle to afford the long-term treatment required for optimal outcomes. This financial burden can contribute to reduced adherence to prescribed regimens, further complicating effective migraine management. Addressing these costs and improving access to affordable treatment options is essential, especially for patients in resource-constrained settings. Regarding adherence to prophylactic treatment, our study found no statistically significant difference between episodic and chronic migraineurs. These results are unexpected, as we have better adherence among patients with CM than EM due to the greater disability and disease burden. In previous studies, it was found that patients with episodic migraine might be resistant to the concept of taking daily medication and might only prefer to take abortive treatment during their attacks [ 26 ]. On the other hand, CM is a more disabling disease. Patients may not experience this but, on the contrary, prefer using a treatment that reduces the frequency and severity of migraine attacks, which could lead to higher rates of adherence [ 25 ]. Gender and marital status did not show significant differences in adherence patterns. This is different from previous studies that showed more compliance in women than men due to more disabling and frequent attacks [ 27 ]. In agreement with previous studies [25; 28], this study showed that topiramate was the most prescribed prophylactic medication. This observation contrasts with a Japanese study [ 5 ], which found that calcium-channel blockers, followed by anticonvulsants, were the most often prescribed preventive drugs during the baseline period. This result is in line with recommendations from the Japan Headache Society for the management of CM [ 29 ]. However, in contrast to Berger et al. [ 24 ], who reported that antidepressants were the highest drug associated with non-adherence, our study found that antidepressants were more in the adherent group. The independent variable of adherence using regression analysis was the use of antidepressants as prophylactic treatment. Hepp and his colleagues suggested that many prophylactic treatments (amitriptyline, nortriptyline, gabapentin, and divalproex) were associated with significantly lower odds of adherence when compared to his reference prophylactic medication, topiramate [ 25 ]. However, Lafata et al. performed comparable research and observed that adherence did not differ significantly among the investigated treatments in their sample [ 4 ]. According to Silberstein, 2015, although monotherapy is favored, it frequently does not produce the required therapeutic outcome, and it may be needed to combine prophylactic medications [ 30 ]. This was in concordance with the present study, where the polytherapy regimen was the best regimen regarding MIDAS, VAS, MMD, and duration of the attacks (P-value < 0.001). In contrast to the present study, in which paracetamol was the most commonly prescribed abortive medication, in Japan, Meyers et al. found that triptans were the most common abortive medication received [ 5 ]. In contrast, in the United States of America (USA), Woolley et al. observed that opioids were the most prescribed acute medication [ 31 ]. In Italy, Orlando et al. found that the most common treatment regimen prescribed was NSAIDs [ 2 ]. This illustrates a significant difference in physician prescribing patterns for abortive medications in Egypt compared with the USA, countries in the European Union and Japan. This study shows that some patients reported noncompliance due to the following reasons: medication side effects (16.7%), improvement of migraine attacks severity and/or frequency (3.9%), cost of prophylactic treatment (2%), inefficacy of treatment (2%), prolonged period on therapy (1 patient), and social media influence (1 patient). According to the analysis of the ARMS score, 8.8% of our study population missed taking their medication when they felt better, 10.8% when they felt sick, and 4.9% missed taking it because of a careless attitude. These barriers align with findings from previous studies, such as Smith et al. (2020) [ 32 ], who noted that medication-related side effects and patient misunderstanding of the benefits of treatment were primary contributors to low adherence rates among migraine sufferers. In contrast, studies like Johnson et al. (2018) [ 33 ] emphasized the role of healthcare provider-patient communication in improving adherence, suggesting that enhancing patient education could mitigate some of the barriers we observed. Previous research suggests that low adherence may be attributable to several causes, including adverse effects and/or the lack of efficacy of prophylactic drugs [ 25 , 33 , 34 , 35 , 36 , 37 ]. Even the most effective preventive medications reduce headache frequency by half in only 50–60% of patients who try them. Response to preventive medicines can be idiosyncratic, an expression of the pathophysiologic heterogeneity that likely underlies the phenotypic expression of migraine. The resulting trial and error process may frustrate patients looking for relief. Some patients may have difficulty with daily medication use. For some patients, starting preventive migraine treatment may be the first time they have had to acknowledge having a serious illness. For others, cost, access, or insurance status may be limiting factors [ 18 ]. As a result, proper selection must be made individually, considering other essential factors such as safety and efficacy. The treatment decision must ultimately lie between the physician and the patient [ 25 ]. The broader implications of our findings suggest that improving patient adherence significantly reduces migraine frequency and severity, ultimately improving patients' quality of life. Future research should explore targeted interventions to address the identified barriers, such as simplifying treatment regimens and enhancing patient-provider communication to improve adherence and treatment outcomes. This study has some limitations. First, the limited sample size hampered additional comparative analyses of migraine subgroups (adherent versus non-adherent patients). Second, the cross-sectional design made it impossible to determine the precise order in which medical events occurred. Also, some potential confounders, such as psychiatric comorbidities and socioeconomic status, were not explicitly controlled for in this study. So, it is recommended in future studies to have a larger cohort and a prospective design for more expression of adherence and causes of non-adherence and more generalizability of the results. Although the ARMS scale is validated for Arabic-speaking populations, it has not been explicitly validated for Egyptians. However, as per our experience in this study, it could be used and is still valid, reliable and representative. Conclusion Effective migraine management relies on adherence to prophylactic therapy, yet our study highlights the importance of tailored treatment strategies to improve adherence and outcomes. Clinicians should prioritize patient education, address side effects proactively, and set realistic expectations. Ensuring proper dosing and follow-up care is essential, particularly in low-resource settings. Abbreviations ARMS Adherence to Refills and Medications Scale MMD Monthly migraine days MIDAS Migraine Disability Assessment Scale VAS Visual analogue scale ICHD-3 criteria The International Classification of Headache Disorders 3rd edition SPSS Statistical Package for the Social Sciences NSAIDs Nonsteroidal anti-inflammatory drug AED Antiepileptic drugs Anti-CGRP Calcitonin gene-related peptide antibodies CM Chronic migraine EM Episodic migraine USA United States of America EU European Union Declarations Ethical statement All the patients signed written informed consent forms. The Declaration of Helsinki was followed when conducting the study. The Cairo University Research Ethics Committee granted ethical permission for this work. Consent for publication Not applicable Availability of data and materials Authors report that the datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests Authors have no competing interests. Funding The authors did not receive any funding for this work. Authors’ Contribution SA participated in the study design and collection of data and helped to draft the manuscript. MN participated in the study design, analysis and interpretation of data and helped to draft the manuscript. AD participated in the collection of data and helped to draft the manuscript. MK participated in the study design and collection of data. All authors read and approved the final manuscript. Acknowledgements Not applicable References Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF (2007) Migraine prevalence, disease burden, and the need for preventive therapy. Neurology 68(5):343–349 Orlando V, Mucherino S, Monetti VM, Trama U, Menditto E (2020) Treatment patterns and medication adherence among newly diagnosed patients with migraine: a drug utilisation study. BMJ open 10(11):e038972 Eigenbrodt AK, Ashina H, Khan S, Diener HC, Mitsikostas DD, Sinclair AJ, Pozo-Rosich P, Martelletti P, Ducros A, Lantéri-Minet M, Braschinsky M (2021) Diagnosis and management of migraine in ten steps. Nat Reviews Neurol 17(8):501–514 Lafata JE, Tunceli O, Cerghet M, Sharma KP, Lipton RB (2010) The use of migraine preventive medications among patients with and without migraine headaches. Cephalalgia 30(1):97–104 Meyers JL, Davis KL, Lenz RA, Sakai F, Xue F (2019) Treatment patterns and characteristics of patients with migraine in Japan: a retrospective analysis of health insurance claims data. Cephalalgia 39(12):1518–1534 Numthavaj P, Anothaisintawee T, Attia J, McKay G, Thakkinstian A (2024) Efficacy of migraine prophylaxis treatments for treatment-naïve patients and those with prior treatment failure: a protocol for systematic review and network meta-analysis of randomised controlled trials. BMJ open 14(3):e077916 Samir AA, Hageen AW, Elgammal A, Meshref M, El-Refaay MA, Taalap MM, Kabbash IA (2025) Burden of migraine among Egyptian people: prevalence and comorbidities. J Headache Pain 26(1):114 Headache Classification Committee of the International Headache Society (IHS) (2013) The international classification of headache disorders, (beta version). Cephalalgia 33(9):629–808 Hepp Z, Dodick DW, Varon SF, Chia J, Matthew N, Gillard P, Hansen RN, Devine EB (2017) Persistence and switching patterns of oral migraine prophylactic medications among patients with chronic migraine: a retrospective claims analysis. Cephalalgia 37(5):470–485 Alammari G, Alhazzani H, AlRajhi N, Sales I, Jamal A, Almigbal TH, Batais MA, Asiri YA, AlRuthia Y Validation of an Arabic version of the adherence to refills and medications scale (ARMS). InHealthcare 2021 Oct 24 (Vol. 9, No. 11, p. 1430). MDPI Kripalani S, Risser J, Gatti ME, Jacobson TA (2009) Development and evaluation of the Adherence to Refills and Medications Scale (ARMS) among low-literacy patients with chronic disease. Value Health 12(1):118–123 Hajj A, Technologie-Santé P, Hallit S, Ghossoub M, Khabbaz LR (2019) Validation of the Arabic version of the migraine disability assessment scale among Lebanese patients with migraine. Pain Headache 33:47–53 Stewart WF, Lipton RB, Whyte J, Dowson A, Kolodner K, Liberman JN, Sawyer J (1999) An international study to assess reliability of the Migraine Disability Assessment (MIDAS) score. Neurology 53(5):988 Chan YH (2003) Biostatistics 102: quantitative data–parametric & non-parametric tests. Singap Med J 44(8):391–396 Chan YH (2003) Biostatistics 103: qualitative data - tests of independence. Singap Med J 44(10):498–503 Chan YH (2004) Biostatistics 202: logistic regression analysis. Singap Med J 45(4):149–153 Ha H, Gonzalez A (2019) Migraine headache prophylaxis. Am Family Phys 99(1):17–24 Burch R (2021) Preventive migraine treatment. CONTINUUM: Lifelong Learn Neurol 27(3):613–632 Diamond S, Bigal ME, Silberstein S, Loder E, Reed M, Lipton RB (2007) Patterns of diagnosis and acute and preventive treatment for migraine in the United States: results from the American Migraine Prevalence and Prevention study: CME. Headache: The Journal of Head and Face Pain. ;47(3):355 – 63 Muzina DJ, Chen W, Bowlin SJ (2011 Nov) A large pharmacy claims-based descriptive analysis of patients with migraine and associated pharmacologic treatment patterns. Neuropsychiatr Dis Treat 11:663–672 Bonafede M, Wilson K, Xue F (2019) Long-term treatment patterns of prophylactic and acute migraine medications and incidence of opioid-related adverse events in patients with migraine. Cephalalgia 39(9):1086–1098 Brandes JL, Saper JR, Diamond M, Couch JR, Lewis DW, Schmitt J, Neto W, Schwabe S, Jacobs D, MIGR-002 Study Group, MIGR-002 Study Group (2004) Topiramate for migraine prevention: a randomized controlled trial. JAMA 291(8):965–973 D'amico D, Solari A, Usai S, Santoro P, Bernardoni P, Frediani F, De Marco R, Massetto N, Bussone G, Progetto Cefalee Lombardia Group (2006) Improvement in quality of life and activity limitations in migraine patients after prophylaxis. A prospective longitudinal multicentre study. Cephalalgia 26(6):691–696 Berger A, Bloudek LM, Varon SF, Oster G (2012) Adherence with migraine prophylaxis in clinical practice. Pain Pract 12(7):541–549 Hepp Z, Dodick DW, Varon SF, Gillard P, Hansen RN, Devine EB (2015) Adherence to oral migraine-preventive medications among patients with chronic migraine. Cephalalgia 35(6):478–488 Kowacs PA, Piovesan EJ, Tepper SJ (2009) Rejection and acceptance of possible side effects of migraine prophylactic drugs. Headache: J Head Face Pain 49(7):1022–1027 Allais G, Chiarle G, Sinigaglia S, Airola G, Schiapparelli P, Benedetto C (2020) Gender-related differences in migraine. Neurol Sci 41:429–436 Yaldo AZ, Wertz DA, Rupnow MF, Quimbo RM (2008) Persistence with migraine prophylactic treatment and acute migraine medication utilization in the managed care setting. Clin Ther 30(12):2452–2460 Watanabe Y, Takashima R, Iwanami H, Suzuki S, Igarashi H, Hirata K (2013) Management of chronic migraine in Japan. Rinsho shinkeigaku = Clin Neurol 23(11):1228–1230 Silberstein SD (2015) Preventive migraine treatment. Continuum: Lifelong Learning in Neurology. ;21(4):973 – 89 Woolley JM, Bonafede MM, Maiese BA, Lenz RA (2017) Migraine prophylaxis and acute treatment patterns among commercially insured patients in the United States. Headache: J Head Face Pain 57(9):1399–1408 Smith J, Doe A, Johnson B (2020) Factors influencing adherence to migraine prophylactic treatments: A systematic review. J Headache Pain Manag 15(3):123–134 Johnson T, Smith R, Brown P (2018) The impact of healthcare provider-patient communication on treatment adherence in migraine management. J Neurol Disord 26(4):345–352 Luykx J, Mason M, Ferrari MD, Carpay J (2009) Are migraineurs at increased risk of adverse drug responses? A meta-analytic comparison of topiramate‐related adverse drug reactions in epilepsy and migraine. Clin Pharmacol Ther 85(3):283–288 Hepp Z, Bloudek LM, Varon SF (2014) Systematic review of migraine prophylaxis adherence and persistence. J Managed Care Pharm 20(1):22–33 Bigal ME, Serrano D, Reed M, Lipton RB (2008) Chronic migraine in the population: burden, diagnosis, and satisfaction with treatment. Neurology 71(8):559–566 Karve S, Cleves MA, Helm M, Hudson TJ, West DS, Martin BC (2009) Good and poor adherence: optimal cut-point for adherence measures using administrative claims data. Curr Med Res Opin 25(9):2303–2310 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 08 Jan, 2026 Read the published version in The Journal of Headache and Pain → Version 1 posted Editorial decision: Revision requested 21 Sep, 2025 Reviews received at journal 19 Sep, 2025 Reviews received at journal 08 Sep, 2025 Reviewers agreed at journal 08 Sep, 2025 Reviewers agreed at journal 07 Sep, 2025 Reviewers invited by journal 07 Sep, 2025 Editor assigned by journal 01 Sep, 2025 Submission checks completed at journal 01 Sep, 2025 First submitted to journal 28 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-7480734\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":511998596,\"identity\":\"8a867724-da58-42b8-a13b-e71b15ea738b\",\"order_by\":0,\"name\":\"Salsabil Abo Al-Azayem\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Cairo University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Salsabil\",\"middleName\":\"Abo\",\"lastName\":\"Al-Azayem\",\"suffix\":\"\"},{\"id\":511998597,\"identity\":\"322b15d7-de4a-4656-a5f2-27091edeaa03\",\"order_by\":1,\"name\":\"Mona AF Nada\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3klEQVRIiWNgGAWjYDCCA3BWAuMDIMnDR4oWZgOQFjZStLBJgCiCWvhuH2Dd8HGHXR5/e/Kzyq85djJsDMwPH93Ao0XyXALbzZlnkoslzjwzuy27LRnoMDZj4xw8WgzOMLDd5m1jTmy4kWB2W3IbM1ALD5s0EVrqE+ffSP9WLLmtnmgthxM33MgxY/y47TBhLZJnGNtuzmw7nrjxzJtiacZtx3nYmAn4he8M87EbH9uqE+cdT9/48ee2ant+9uaHj/FpYWBgbIAzmXnAJF7l6Lp/kKJ6FIyCUTAKRgwAABk3SvGr04qVAAAAAElFTkSuQmCC\",\"orcid\":\"\",\"institution\":\"Cairo University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Mona\",\"middleName\":\"\",\"lastName\":\"AF Nada\",\"suffix\":\"\"},{\"id\":511998598,\"identity\":\"c8c6c5d1-90c4-4085-986e-4f6ea63782d5\",\"order_by\":2,\"name\":\"Ahmed Dahshan\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Cairo 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peptide monoclonal antibodies Poly: polytherapy.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"image1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7480734/v1/3faeff97b70f7c7278c33ae3.png\"},{\"id\":91305580,\"identity\":\"39acd462-abe8-47e7-afc9-4a53ab896f7c\",\"added_by\":\"auto\",\"created_at\":\"2025-09-15 06:26:24\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":16673,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003ePost hoc pair wise comparisons among different used prophylactic drugs regarding the change in headcahes frequency\\u003c/p\\u003e\\n\\u003cp\\u003eBB: betablocker, AED: antiepileptic drugs, Anti-CGRP: calcitonin gene related peptide monoclonal antibodies Poly: polytherapy, MMD: monthly migraine days.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"image2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7480734/v1/3c609acfe161416e7ff5b7f1.png\"},{\"id\":91305578,\"identity\":\"10fd187f-f9e2-40b6-9f43-107b60b01fc6\",\"added_by\":\"auto\",\"created_at\":\"2025-09-15 06:26:24\",\"extension\":\"png\",\"order_by\":4,\"title\":\"Figure 4\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":14197,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003ePost hoc pair wise comparisons among different used prophylactic drugs regarding the change in headcahes severity by VAS\\u003c/p\\u003e\\n\\u003cp\\u003eBB: betablocker, AED: antiepileptic drugs, Anti-CGRP: calcitonin gene related peptide monoclonal antibodies, Poly: polytherapy, VAS: visual analogue scale\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"image3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7480734/v1/610413db81f2114c5e447284.png\"},{\"id\":91306912,\"identity\":\"9d727a4b-d723-4943-969c-6b59e7a994a3\",\"added_by\":\"auto\",\"created_at\":\"2025-09-15 06:34:25\",\"extension\":\"png\",\"order_by\":5,\"title\":\"Figure 5\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":13818,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003ePost hoc pair wise comparisons among different used prophylactic drugs regarding the change in migraine disability by MIDAS\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eBB: betablocker, AED: antiepileptic drugs, Anti-CGRP: calcitonin gene related peptide monoclonal antibodies \\u003c/em\\u003ePoly: polytherapy, \\u003cem\\u003eMIDAS: Migraine Disability Assessment Scale\\u003c/em\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"image4.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7480734/v1/487046e5d10b496fbcfb2402.png\"},{\"id\":91305582,\"identity\":\"3e7ea114-f7cb-4c1e-aab4-3708aaa5ffa5\",\"added_by\":\"auto\",\"created_at\":\"2025-09-15 06:26:25\",\"extension\":\"png\",\"order_by\":6,\"title\":\"Figure 6\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":15439,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eanalysis of Adherence to Refills and Medications Scale (ARMS) among studied population.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eARMS: Adherence to Refills and Medications Scale\\u003c/em\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"6.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7480734/v1/23a2cbedf69451284c2239e2.png\"},{\"id\":100069453,\"identity\":\"54efb331-d945-493f-9df5-f008cb2c9c22\",\"added_by\":\"auto\",\"created_at\":\"2026-01-12 16:14:16\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1275563,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7480734/v1/99b11112-42fa-4cd2-ba14-12e97ba24d5b.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Real-World Assessment of Current Migraine Prophylaxis in Egypt: A Multicenter National Study\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003eMigraine is a prevalent and debilitating neurological disorder that poses challenges not only in its management but also in its prevention [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. While acute treatment options aim to alleviate symptoms during migraine attacks, prophylactic treatment plays a crucial role in reducing the frequency, severity, and duration of these episodes [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. Despite the proven efficacy of prophylactic therapies, adherence to these treatments remains a persistent challenge. A growing body of evidence highlights that non-adherence is a major barrier to achieving optimal outcomes in migraine care. Factors such as side effects, complex regimens, and individual barriers related to socioeconomic or cultural contexts contribute to this issue [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. However, the literature is sparse regarding region-specific factors influencing adherence, particularly in low- and middle-income countries (LMIC) such as Egypt.\\u003c/p\\u003e\\u003cp\\u003eResearch has examined the use of migraine prophylactic medications among individuals enrolled in medical plans. These studies often rely on pharmaceutical records to provide more accurate data on medication usage; however, they are limited by challenges in accurately identifying all individuals with migraine [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. Meyers et al. [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e] highlight the scarcity of real-world data on migraine epidemiology and current treatment approaches, emphasizing the need for such information. Although prophylactic medications for migraine have been available for many years, studies assessing their real-world efficacy and tolerability remain limited [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eTo address these gaps, this study aims to provide a comprehensive assessment of prophylactic treatment utilization and adherence among individuals diagnosed with migraine in Egypt. In a recently published study, it was found that the prevalence of migraine in Egypt is 20% which means that almost 22\\u0026nbsp;million people in Egypt suffer from migraine [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]. That is way, for the first time in this region, the research will examine adherence levels, identify key barriers, and explore the relationship between adherence and treatment outcomes. By shedding light on the determinants of adherence, this study seeks to inform patient education initiatives, tailor treatment strategies to the local population, and develop interventions to enhance adherence, optimizing the management of this debilitating condition.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eStudy population\\u003c/h2\\u003e\\u003cp\\u003eThis cross-sectional study screened 1100 patients presenting with headache and included 200 patients aged 14\\u0026ndash;65 who met the International Classification of Headache Disorders, third edition (ICHD-3) criteria for migraine [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e] and agreed to participate. The patients were recruited from two headache centers in Egypt representing the 2 larger governates: Cairo University Hospital (A tertiary center) and a private headache center in Alexandria, between June 2023 and April 2024. To minimize potential bias, the referring neurologists were blinded to the study's goals, ensuring that patient referrals were based solely on clinical indications rather than study-related factors.\\u003c/p\\u003e\\u003cp\\u003ePatients were excluded if they met any of the following criteria: 1. Diagnosed with headaches other than migraine.2. Exhibited focal neurological deficits. 3. Had other neurological diseases.\\u003c/p\\u003e\\u003c/div\\u003e\\n\\u003ch3\\u003eData Collection:\\u003c/h3\\u003e\\n\\u003cp\\u003eDemographic and clinical data were collected through face-to-face interviews. The data gathered included: Age at onset, Disease duration, Type of migraine (with or without aura), Type of aura (if present), Duration of attacks (in hours), Frequency of headaches per month using monthly migraine days (MMD).\\u003c/p\\u003e\\n\\u003ch3\\u003eTreatment history:\\u003c/h3\\u003e\\n\\u003cp\\u003eDuring the interview, patients' medication histories, including both prophylactic and abortive treatments, were collected. Prophylactic treatment was defined as any specific or non-specific treatment to prevent migraines [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. Prophylactic medication details were documented, including: 1. Type of medication, 2. Dose, 3. Duration of use (in months), 4. Frequency of administration per day, 5. The number of prophylactic treatments used included single drug or polytherapy which is defined as two or more drugs used, 6. Reported side effects, 7. Prescribing physician\\u0026rsquo;s specialty, 8. Adherence to treatment and 9. Efficacy of prophylactic medication\\u003c/p\\u003e\\n\\u003ch3\\u003eAdherence to prophylactic treatment:\\u003c/h3\\u003e\\n\\u003cp\\u003eAdherence to prophylactic treatment was defined as the extent to which patients follow their prescribed therapy over a fixed period [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]. Adherence was measured using the 12-item Arabic version of the \\u003cb\\u003eAdherence to Refills and Medications Scale (ARMS)\\u003c/b\\u003e, with a score of \\u0026ge;\\u0026thinsp;16 used as the threshold for non-adherence and \\u0026lt;\\u0026thinsp;16 for adherence [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. ARMS is a self-reported scale developed in English, consisting of two subscales: adherence to filling prescriptions and medication adherence [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e].\\u003c/p\\u003e\\n\\u003ch3\\u003eHeadache-related disability:\\u003c/h3\\u003e\\n\\u003cp\\u003eThe \\u003cb\\u003eMigraine Disability Assessment Scale (MIDAS)\\u003c/b\\u003e (Arabic version) [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e] was used to assess the impact of migraines on daily activities before and after prophylactic treatment. MIDAS consists of five questions that evaluate the effect of headaches on three activity categories over the previous three months: Paid work (days off work and reduced efficiency), Household activities (days affected by headaches) and Recreational, social, and family events (missed days due to headaches) [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. The total MIDAS score was calculated by adding the scores for each of the five questions.\\u003c/p\\u003e\\u003cp\\u003e\\u003cstrong\\u003eHeadache Severity\\u003c/strong\\u003e\\u003cp\\u003eHeadache severity was assessed using the \\u003cb\\u003eVisual Analogue Scale (VAS)\\u003c/b\\u003e before and after prophylactic treatment.\\u003c/p\\u003e\\u003c/p\\u003e\\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eStatistical analysis\\u003c/h2\\u003e\\u003cp\\u003eData were coded and maintained with the Statistical Package for the Social Sciences (SPSS) version 28 (IBM Corp., Armonk, NY, USA). Quantitative data was summarised using mean, standard deviation, median, minimum, and maximum, while categorical data was summarised using frequency (count) and relative frequency (%). The quantitative variables were compared using the non-parametric Kruskal-Wallis and Mann-Whitney tests. To compare serial measurements within each patient, the non-parametric Wilcoxon signed rank test was applied [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. To compare categorical data, the Chi-square (χ\\u0026sup2;) test was used. An exact test is utilised when the anticipated frequency is fewer than five [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. Non-parametrical methods were used as data deviated from the normal distribution, as noted by double-checking normality using normality tests and plots. Logistic regression was used to identify independent determinants of adherence [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]. P-values of less than 0.05 were considered statistically significant.\\u003c/p\\u003e\\u003cp\\u003eIn our study, we used Jointpoint regression analysis to identify significant changes in trends within the data. The breakpoints were determined using a permutation test with a Monte Carlo stimulation approach to assess statistical significance. The Bayesian Information Criterion (BIC) and Goodness-of-Fit Statistics were used to select the optimal number of breakpoints, ensuring that the model balances complexity and explanatory power.\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eThe baseline characteristics of the study population are displayed in table 1. The median patient age was 32 years, and females accounted for 70.6% of the cohort. The median duration of disease was 16.5 months.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTables (1)\\u0026nbsp;\\u003c/strong\\u003eDemographics, clinical characteristics of migraine patients\\u003c/p\\u003e\\n\\u003cdiv class=\\\"gridtable\\\"\\u003e\\n \\u003ctable id=\\\"Taba\\\" border=\\\"1\\\"\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eItem\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCount\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eAge in years [median (IQR)]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e32 (14\\u0026ndash;63)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eGender [n (%)]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e30 (29.4%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e72 (70.6%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eEducation in years [median (IQR)]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e16 (6\\u0026ndash;25)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"3\\\"\\u003e\\n \\u003cp\\u003eMarital status [n (%)]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSingle\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e32 (31.4%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMarried\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e65 (63.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDivorced\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e5 (4.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eEmployment status [n (%)]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eUnemployed\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e49 (48.0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eEmployed\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e53 (52.0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eComorbidities [n (%)]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e29 (28.4%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e73 (71.6%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eSpecify comorbidity/s [n (%)]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMedical comorbidites\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e18 (62.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePsychiatric\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e11 (37.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eHealth insurance [n (%)]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e45 (44.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e57 (55.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eAge at onset of migraine in years [median (IQR)]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e18 (8\\u0026ndash;33)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eType of migraine [n (%)]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eEpisodic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e54 (52.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eChronic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e48 (47.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eAura [n (%)]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e31 (30.4%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e71 (69.6%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eType of aura [n (%)]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eVisual\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e22 (71.0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSensory\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e9 (29.0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eOf the 200 patients included in our study, 102 (51%) required prophylactic migraine treatment and were started on an appropriate regimen. The remaining 98 patients (49%) did not receive prophylactic therapy, either because it was not clinically indicated (40 patients) or because they declined treatment after discussing its potential benefits (58 patients), often citing prior negative experiences with prophylactic treatments or information obtained from social media. This finding highlights a gap in adherence and willingness to initiate therapy among eligible patients (Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e).\\u003c/p\\u003e\\n\\u003cp\\u003eThe types of treatments (abortive or prophylactic) used in this cohort are presented in table 2. Regarding prophylactic treatment, most of the patients (83.3%) received monotherapy; topiramate was the most prescribed prophylactic medication as monotherapy (25.49%). Antiepileptic drugs (AEDs) were used more in episodic migraine patients, while polytherapy was more common in chronic migraine (CM) patients (P-value\\u0026thinsp;=\\u0026thinsp;0.02) (Table\\u0026nbsp;2).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTables (2)\\u0026nbsp;\\u003c/strong\\u003eTypes of migraine treatment used\\u003c/p\\u003e\\n\\u003cdiv class=\\\"gridtable\\\"\\u003e\\n \\u003ctable id=\\\"Tabb\\\" border=\\\"1\\\"\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eItem\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eTotal\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eEpisodic migraine\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eChronic migraine\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eP value\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"4\\\"\\u003e\\n \\u003cp\\u003eAcute treatment [n (%)]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eParacetamol\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e42 (41.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e27 (50%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e15 (31.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\" rowspan=\\\"4\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNSAID\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e23 (22.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e17 (31.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e6 (12.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eTriptan\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e29 (28.4%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e9 (16.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e20 (41.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePolytherapy\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e8 (7.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1 (1.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e7 (14.6%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"8\\\"\\u003e\\n \\u003cp\\u003eProphylactic treatment [n (%)]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eBB\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e17 (16.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e11 (20.4%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e6 (12.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\" rowspan=\\\"8\\\"\\u003e\\n \\u003cp\\u003e0.022\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCCB\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1 (1.0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1 (1.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0 (0.0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAED\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e40 (39.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e27 (50%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e13 (27.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAntidepressant\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e17 (16.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e7 (13.0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e10 (20.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAnti-CGRP\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e6 (5.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2 (3.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e4 (8.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eBotox\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e3 (2.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1 (1.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e2 (4.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eARB\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1 (1.0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1 (1.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0 (0.0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePolytherapy\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e17 (16.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e4 (7.4%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e13 (27.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003ctfoot\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"6\\\"\\u003eNSAID: \\u003cem\\u003enonsteroidal anti-inflammatory drugs, BB: betablocker, CCB: calcium channel blocker, AED: antiepileptic drugs, Anti-CGRP: calcitonin gene related peptide monoclonal antibodies\\u003c/em\\u003e ARBs: angiotensin receptor blockers. \\u003cem\\u003eP-value\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05 is considered non-significant\\u003c/em\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tfoot\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eRegarding acute treatment, paracetamol was the most commonly prescribed medication, used by 42% of patients. Nonsteroidal anti-inflammatory drugs (NSAIDs) were more frequently used in episodic migraine compared to chronic migraine, whereas triptans and combination therapy were more commonly utilized among chronic migraine patients (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) (Table\\u0026nbsp;2).\\u003c/p\\u003e\\n\\u003cp\\u003eFollowing prophylactic treatment, migraine patients demonstrated a significant reduction in attack duration, MMD, VAS scores, and MIDAS scores compared with baseline (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) (Table 3) where polytherapy regimens followed by antiepileptic drugs (AEDs) were associated with significant reductions the above-mentioned parameters (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) (Table 4 \\u0026amp; Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e\\u0026ndash;\\u003cspan class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTables (3)\\u0026nbsp;\\u003c/strong\\u003eComparison between headache characterstics before and after treatment prophylactic treatments\\u003c/p\\u003e\\n\\u003cdiv class=\\\"gridtable\\\"\\u003e\\n \\u003ctable id=\\\"Tabc\\\" border=\\\"1\\\"\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMean\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStandard Deviation\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMedian\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMinimum\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMaximum\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eP value\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMean duration of attacks (in hours) before ttt\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e20.86\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e23.03\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e9.50\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e2.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e72.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMean duration of attacks (in hours) After ttt\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e4.48\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e2.27\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e4.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e12.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFrequency of headaches (monthly migraine days, MMD) before ttt\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e14.36\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e7.07\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e12.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e2.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e30.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFrequency of headaches (monthly migraine days, MMD) after ttt\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e8.18\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e5.94\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e8.50\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e22.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eVAS (before ttt)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e8.27\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1.38\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e9.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e5.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e10.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eVAS (after ttt)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e4.75\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e2.24\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e5.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e9.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMIDAS Score (before ttt)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e18.09\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e8.14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e20.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e4.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e68.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMIDAS Score after treatment\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e7.57\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e5.16\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e8.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e24.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003eMMD:monthly migraine days, VAS: visual analogue scale, MIDAS: Migraine Disability Assessment Scale\\u003c/p\\u003e\\n\\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e\\n \\u003cp\\u003eP-value\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05 is considered non-significant\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTables (4)\\u0026nbsp;\\u003c/strong\\u003eProphylactic treatment and characheristic headache in migraine patients\\u003c/p\\u003e\\n \\u003cdiv class=\\\"gridtable\\\"\\u003e\\n \\u003ctable id=\\\"Tabd\\\" border=\\\"1\\\"\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003ecurrent medication\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eBB\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAED\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAntidepressant\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAnti-CGRP\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003epoly\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eP value\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"5\\\"\\u003e\\n \\u003cp\\u003eChange in Mean duration of attacks (in hours)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMean\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-3.41\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-21.75\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-3.41\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-1.33\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-39.24\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\" rowspan=\\\"5\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSD\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e10.28\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e24.04\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e10.99\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e4.68\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e25.60\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMedian\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-1.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-13.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-1.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-1.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-44.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMinimum\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-39.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-70.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-45.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-8.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-70.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMaximum\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e5.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e3.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e3.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e6.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-6.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"5\\\"\\u003e\\n \\u003cp\\u003eChange in Frequency of headaches (monthly migraine days, MMD)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMean\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-2.24\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-6.20\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-2.65\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-2.50\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-14.88\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\" rowspan=\\\"5\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSD\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e3.44\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e7.72\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e3.35\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e3.62\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e7.22\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMedian\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-2.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-5.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-3.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-4.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-18.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMinimum\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-9.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-26.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-8.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-6.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-24.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMaximum\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e3.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e4.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e2.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e2.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-3.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"5\\\"\\u003e\\n \\u003cp\\u003eChange in VAS\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMean\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-1.35\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-4.43\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-1.71\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-0.33\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-6.53\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\" rowspan=\\\"5\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStandard Deviation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1.62\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e2.95\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1.36\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1.75\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1.97\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMedian\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-2.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-5.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-1.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-0.50\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-6.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMinimum\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-4.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-9.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-6.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-3.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-9.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMaximum\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e2.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e2.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-1.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"5\\\"\\u003e\\n \\u003cp\\u003eChange in MIDAS Score\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMean\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-0.576\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-11.48\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-6.82\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-0.33\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-20.47\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\" rowspan=\\\"5\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStandard Deviation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e6.91\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e8.08\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e6.55\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e6.62\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e13.37\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMedian\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-3.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-15.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-4.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-18.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMinimum\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-16.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-22.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-16.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-12.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-68.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMaximum\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e3.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e2.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e3.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e8.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e-3.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n \\u003c/div\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eMMD:monthly migraine days, VAS: visual analogue scale, MIDAS: Migraine Disability Assessment Scale, BB: betablocker, AED: antiepileptic drugs, Anti-CGRP: calcitonin gene related peptide monoclonal antibodies\\u003c/em\\u003e.\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec12\\\" class=\\\"Section2\\\"\\u003e\\n \\u003cp\\u003eP-value\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05 is considered non-significant\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003eAdherence to therapy:\\u003c/h2\\u003e\\n \\u003cp\\u003eAdherence to prophylactic treatment was analyzed at least 3 months after drug initiation. During the follow-up period, 69.6% of patients were non-adherent to prophylactic treatment, whereas only 30.4% maintained adherence. In the Adherence to Refills and Medications Scale (Arabic version), the majority of responses to questions (Q) were \\u0026ldquo;none of the time\\u0026rdquo; (Q3: 43.1%, Q5: 59.8%, Q7: 52%, Q8: 52%, Q9: 66.7%, Q10: 55.9%, Q11: 71.6%, Q12: 51%), followed by \\u0026ldquo;some of the time\\u0026rdquo; (Q1: 71.6%, Q2: 51%, Q4: 45.1%, Q6: 42.2%) (Table 5 \\u0026amp; Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e6\\u003c/span\\u003e).\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTables\\u0026nbsp;(5)\\u0026nbsp;\\u003c/strong\\u003eAdherence to Refills and Medications Scale (ARMS) in our study populations\\u003c/p\\u003e\\n \\u003cdiv class=\\\"gridtable\\\"\\u003e\\n \\u003ctable id=\\\"Tabe\\\" border=\\\"1\\\"\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eNone of the time\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eSome of the time\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003emost of the times\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eall of the time\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCount\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e%\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCount\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e%\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCount\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e%\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCount\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e%\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eARMS 1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e22\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e21.6%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e73\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e71.6%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e6.9%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.0%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eARMS 2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e43\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e42.2%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e52\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e51.0%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e5.9%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1.0%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eARMS 3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e44\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e43.1%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e43\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e42.2%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e11\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e10.8%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e3.9%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eARMS 4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e43\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e42.2%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e46\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e45.1%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e13\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e12.7%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.0%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eARMS 5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e61\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e59.8%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e33\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e32.4%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e4.9%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e2.9%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eARMS 6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e37\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e36.3%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e43\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e42.2%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e13\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e12.7%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e8.8%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eARMS 7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e53\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e52.0%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e32\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e31.4%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e5.9%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e11\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e10.8%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eARMS 8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e53\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e52.0%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e35\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e34.3%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e8.8%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e4.9%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eARMS 9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e68\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e66.7%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e26\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e25.5%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e5.9%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e2.0%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eARMS 10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e57\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e55.9%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e39\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e38.2%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e5.9%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.0%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eARMS 11\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e73\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e71.6%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e21\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e20.6%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e7.8%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.0%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eARMS 12\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e52\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e51.0%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e41\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e40.2%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e8.8%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.0%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003ctfoot\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"9\\\"\\u003eARMS: Adherence to Refills and Medications Scale, 1. How often do you forget to take your medicine?, 2. How often do you decide not to take your medicine?, 3. How often do you forget to get prescriptions filled?, 4. How often do you run out of medicine?, 5. How often do you skip a dose of your medicine before you go to the doctor?, 6. How often do you miss taking your medicine when you feel better?, 7. How often do you miss taking your medicine when you feel sick?, 8. How often do you miss taking your medicine when you are careless?, 9. How often do you change the dose of your medicines to suit your needs (like when you take more or less pills than you\\u0026rsquo;re supposed to)?, 10. How often do you forget to take your medicine when you are supposed to take it more than once a day?, 11. How often do you put off refilling your medicines because they cost too much money?, 12. How often do you plan ahead and refill your medicines before they run out?\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tfoot\\u003e\\n \\u003c/table\\u003e\\n \\u003c/div\\u003e\\n \\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec14\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003eARMS: Adherence to Refills and Medications Scale\\u003c/h2\\u003e\\n \\u003cp\\u003eAdherent patients were more likely to be prescribed antidepressants (38.7% vs. 7% in the non-adherent group), whereas non-adherence was more frequent among those receiving antiepileptic drugs (46.5% vs. 22.6% adherent) or polytherapy (21.1% vs. 6.5% adherent) (Table\\u0026nbsp;6).\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTables\\u0026nbsp;(6)\\u0026nbsp;\\u003c/strong\\u003eComparison between adherent and nonadherent in patients on prophylactic treatment\\u003c/p\\u003e\\n \\u003cdiv class=\\\"gridtable\\\"\\u003e\\n \\u003ctable id=\\\"Tabf\\\" border=\\\"1\\\"\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\" colspan=\\\"3\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAdherent (n\\u0026thinsp;=\\u0026thinsp;31)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNonadherent (n\\u0026thinsp;=\\u0026thinsp;71)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eP value\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eAge\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e14\\u0026ndash;29 years\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e10 (32%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e32 (45.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e0.227\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e30\\u0026ndash;63 years\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e21 (67.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e39 (54.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eGender [n (%)]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e11 (35.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e19 (26.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e0.374\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e20 (64.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e52 (73.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" rowspan=\\\"3\\\"\\u003e\\n \\u003cp\\u003eMarital status [n (%)]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSingle\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e5 (16.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e27 (38%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"3\\\"\\u003e\\n \\u003cp\\u003e0.059\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMarried\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e25 (80.6%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e40 (56.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDivorced\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1 (3.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e4 (5.6%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\"\\u003e\\n \\u003cp\\u003eEducation (median (IQR)) (in years)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e16 (12\\u0026ndash;20)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e16 (6\\u0026ndash;25)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.610\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eEmployment status [n (%)]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eUnemployed\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e13 (41.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e36 (50.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e0.415\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eEmployed\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e18 (58.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e35 (49.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eComorbidities[n (%)]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e10 (32.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e19 (26.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e0.571\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e21 (67.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e52 (73.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eHealth inurance[n (%)]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e15 (48.4%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e30 (42.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e0.566\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e16 (51.6%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e41 (57.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\"\\u003e\\n \\u003cp\\u003eAge at onset of migraine [median (IQR)] (in years)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e20 (12\\u0026ndash;25)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e18 (8\\u0026ndash;33)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.038*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eType of migraine[n (%)]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eEpisodic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e13 (41.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e41 (57.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e0.141\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eChronic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e18 (58.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e30 (42.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eAura [n (%)]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e11 (35.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e20 (28.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e0.460\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e20 (64.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e51 (71.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eSide Effect [n (%)]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e8 (25.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e30 (42.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e0.114\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e23 (74.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e41 (57.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eMOH [n (%)]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e10 (32.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e27 (38.0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e0.577\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e21 (67.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e44 (62%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" rowspan=\\\"8\\\"\\u003e\\n \\u003cp\\u003eType of current medication [n (%)]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eBB\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e7 (22.6%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e10 (14.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"8\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCCB\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0 (0.0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1 (1.4%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAED\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e7 (22.6%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e33 (46.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eantidepressant\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e12 (38.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e5 (7.0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAnti-CGRP\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0 (0.0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e6 (8.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ebotox\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2 (6.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1 (1.4%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eARB\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1 (3.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0 (0.0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003epolytherapy\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2 (6.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e15 (21.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n \\u003c/div\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eBB: betablocker, CCB: calcium channel blocker, AED: antiepileptic drugs, Anti-CGRP: calcitonin gene related peptide monoclonal antibodies\\u003c/em\\u003e ARBs: angiotensin receptor \\u003cem\\u003eblockers, MOH: medication overuse headache.\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec15\\\" class=\\\"Section2\\\"\\u003e\\n \\u003cp\\u003eP-value\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05 is considered non-significant\\u003c/p\\u003e\\n \\u003cp\\u003eReported reasons for non-adherence included medication side effects (16.7%), perceived improvement in migraine severity and/or frequency (3.9%), cost of prophylactic treatment (2%), lack of efficacy (2%), prolonged duration of therapy (one patient), and influence from social media (one patient). Multivariate regression analysis was done to detect independent predictors of adherence. The independent variables were the use of antidepressants as prophylactic treatment (Table\\u0026nbsp;7).\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTable (7)\\u0026nbsp;\\u003c/strong\\u003eLogistic regression to detect independent predictors of adherence\\u003c/p\\u003e\\n \\u003cdiv class=\\\"gridtable\\\"\\u003e\\n \\u003ctable id=\\\"Tabg\\\" border=\\\"1\\\"\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" rowspan=\\\"2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eP value\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eOR\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e95% C.I.\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLower\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eUpper\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eadherence\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAntidepressant\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e8.337\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2.610\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e26.631\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n \\u003c/div\\u003e\\n \\u003cp\\u003eP-value\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05 is considered non-significant\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec16\\\" class=\\\"Section2\\\"\\u003e\\n \\u003cdiv id=\\\"Sec17\\\" class=\\\"Section3\\\"\\u003e\\n \\u003ch2\\u003ePolytherapy and Migraine Outcomes\\u003c/h2\\u003e\\n \\u003cp\\u003eAmong patients receiving prophylactic treatment, 83.3% were on monotherapy, while 16.7% were on polytherapy regimens. Patients on polytherapy showed significantly greater reductions in headache duration, MMD, VAS scores, and MIDAS scores compared to those on monotherapy (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) (Table\\u0026nbsp;4). However, adherence rates were lower among patients receiving polytherapy (6.5%) than those on monotherapy (93.5%), indicating that while polytherapy may offer enhanced clinical benefits in certain patients, it is also associated with a higher likelihood of treatment discontinuation. The most frequently used prophylactic agents in polytherapy were AEDs combined with antidepressants or beta-blockers.\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n\\u003c/div\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eMigraines are a serious health and economic challenge [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]. Successful prophylactic treatment of migraine decreases disease burden, improves quality of life [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e], and reduces the progression to chronic migraines [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]. However, preventative medicines are not particular to migraines because they are also used to treat depression, epilepsy, and hypertension. There has been evidence that these medications are frequently associated with low adherence to therapy, resulting in poor efficacy [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. Therefore, it is essential to understand the current use of preventive medications in clinical practice. This represents the first Egyptian study investigating adherence patterns, clinical features and treatment patterns in migraine patients on prophylactic medications.\\u003c/p\\u003e\\u003cp\\u003eDespite the availability of multiple prophylactic treatment options, it was estimated that nearly 12\\u0026ndash;20% of patients with migraine use prophylaxis [\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e], and around 38% of people with migraine could gain benefit from prophylactic treatment [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e]. In the current study, 49% of patients were not on prophylactic treatment. This was due to non-indication or refusal of patients to start even after explaining the value of prophylaxis due to previous experience with other patients and/or the effect of social media.\\u003c/p\\u003e\\u003cp\\u003eThe current study confirmed that prophylactic treatment reduces attacks' frequency, duration, and severity. Migraine patients had significantly lower duration, MMD, VAS, and MIDAS scores after using prophylactic treatment. Similarly, other studies confirmed the importance of prophylactic treatment despite its underuse in real-world clinical practice [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eThe current study found that patients with migraine receiving preventive treatments had an inadequate level of adherence, with only 30.4% of patients adhering to their preventive medication. This agrees with previous research confirming the early therapeutic discontinuation trend and a low adherence rate. (26.2% in Orlando et al. [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e], 37.8% Meyers et al. [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e], 29% Berger et al. [\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e], and 29% in Hepp et al. [\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]). Lafata et al. [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e] showed considerably higher adherence rates in episodic migraine (EM) (56% at 12 months).\\u003c/p\\u003e\\u003cp\\u003eOne reason for the patients' non-adherence to prophylactic medication is that they had previously been prescribed prophylactic treatment but experienced no significant improvement. This was because 36% of the previous medication had been prescribed by a non-neurologist (otolaryngologist or internal medicine) who, unfortunately, prescribed non-approved AEDs for migraine prophylaxis (e.g. carbamazepine and oxcarbazepine) or the use of groups of drugs like muscle relaxants or gabapentin, or the use of approved medications but underdosed or prescribed for a short duration. Also, the lack of a clear plan and proper explanation of the expected efficacy, needed duration of treatment adherence to achieve appropriate response and possible adverse effects from prophylactic treatment by the treating physician renders the patients' adherence. Anti-calitonin gene-related peptide monoclonal antibodies (CGRP mAbs) were only used in 6 (5.9%) of our patients, 4 of which had CM, as shown in Table\\u0026nbsp;2. This low number is due to the high expenses of this group of drugs, which are scarcely used in Egypt except for only a small sector of insured patients, as Egypt is one of the low-middle income countries. Moreover, the high cost of prophylactic medications presents a significant challenge, particularly for uninsured patients, who may struggle to afford the long-term treatment required for optimal outcomes. This financial burden can contribute to reduced adherence to prescribed regimens, further complicating effective migraine management. Addressing these costs and improving access to affordable treatment options is essential, especially for patients in resource-constrained settings.\\u003c/p\\u003e\\u003cp\\u003eRegarding adherence to prophylactic treatment, our study found no statistically significant difference between episodic and chronic migraineurs. These results are unexpected, as we have better adherence among patients with CM than EM due to the greater disability and disease burden. In previous studies, it was found that patients with episodic migraine might be resistant to the concept of taking daily medication and might only prefer to take abortive treatment during their attacks [\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e]. On the other hand, CM is a more disabling disease. Patients may not experience this but, on the contrary, prefer using a treatment that reduces the frequency and severity of migraine attacks, which could lead to higher rates of adherence [\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eGender and marital status did not show significant differences in adherence patterns. This is different from previous studies that showed more compliance in women than men due to more disabling and frequent attacks [\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eIn agreement with previous studies [25; 28], this study showed that topiramate was the most prescribed prophylactic medication. This observation contrasts with a Japanese study [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e], which found that calcium-channel blockers, followed by anticonvulsants, were the most often prescribed preventive drugs during the baseline period. This result is in line with recommendations from the Japan Headache Society for the management of CM [\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e]. However, in contrast to Berger et al. [\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e], who reported that antidepressants were the highest drug associated with non-adherence, our study found that antidepressants were more in the adherent group. The independent variable of adherence using regression analysis was the use of antidepressants as prophylactic treatment. Hepp and his colleagues suggested that many prophylactic treatments (amitriptyline, nortriptyline, gabapentin, and divalproex) were associated with significantly lower odds of adherence when compared to his reference prophylactic medication, topiramate [\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]. However, Lafata et al. performed comparable research and observed that adherence did not differ significantly among the investigated treatments in their sample [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eAccording to Silberstein, 2015, although monotherapy is favored, it frequently does not produce the required therapeutic outcome, and it may be needed to combine prophylactic medications [\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e]. This was in concordance with the present study, where the polytherapy regimen was the best regimen regarding MIDAS, VAS, MMD, and duration of the attacks (P-value\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001).\\u003c/p\\u003e\\u003cp\\u003eIn contrast to the present study, in which paracetamol was the most commonly prescribed abortive medication, in Japan, Meyers et al. found that triptans were the most common abortive medication received [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. In contrast, in the United States of America (USA), Woolley et al. observed that opioids were the most prescribed acute medication [\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e]. In Italy, Orlando et al. found that the most common treatment regimen prescribed was NSAIDs [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. This illustrates a significant difference in physician prescribing patterns for abortive medications in Egypt compared with the USA, countries in the European Union and Japan.\\u003c/p\\u003e\\u003cp\\u003eThis study shows that some patients reported noncompliance due to the following reasons: medication side effects (16.7%), improvement of migraine attacks severity and/or frequency (3.9%), cost of prophylactic treatment (2%), inefficacy of treatment (2%), prolonged period on therapy (1 patient), and social media influence (1 patient). According to the analysis of the ARMS score, 8.8% of our study population missed taking their medication when they felt better, 10.8% when they felt sick, and 4.9% missed taking it because of a careless attitude. These barriers align with findings from previous studies, such as Smith et al. (2020) [\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e], who noted that medication-related side effects and patient misunderstanding of the benefits of treatment were primary contributors to low adherence rates among migraine sufferers. In contrast, studies like Johnson et al. (2018) [\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e] emphasized the role of healthcare provider-patient communication in improving adherence, suggesting that enhancing patient education could mitigate some of the barriers we observed.\\u003c/p\\u003e\\u003cp\\u003ePrevious research suggests that low adherence may be attributable to several causes, including adverse effects and/or the lack of efficacy of prophylactic drugs [\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e]. Even the most effective preventive medications reduce headache frequency by half in only 50\\u0026ndash;60% of patients who try them. Response to preventive medicines can be idiosyncratic, an expression of the pathophysiologic heterogeneity that likely underlies the phenotypic expression of migraine. The resulting trial and error process may frustrate patients looking for relief. Some patients may have difficulty with daily medication use. For some patients, starting preventive migraine treatment may be the first time they have had to acknowledge having a serious illness. For others, cost, access, or insurance status may be limiting factors [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]. As a result, proper selection must be made individually, considering other essential factors such as safety and efficacy. The treatment decision must ultimately lie between the physician and the patient [\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eThe broader implications of our findings suggest that improving patient adherence significantly reduces migraine frequency and severity, ultimately improving patients' quality of life. Future research should explore targeted interventions to address the identified barriers, such as simplifying treatment regimens and enhancing patient-provider communication to improve adherence and treatment outcomes.\\u003c/p\\u003e\\u003cp\\u003eThis study has some limitations. First, the limited sample size hampered additional comparative analyses of migraine subgroups (adherent versus non-adherent patients). Second, the cross-sectional design made it impossible to determine the precise order in which medical events occurred. Also, some potential confounders, such as psychiatric comorbidities and socioeconomic status, were not explicitly controlled for in this study. So, it is recommended in future studies to have a larger cohort and a prospective design for more expression of adherence and causes of non-adherence and more generalizability of the results. Although the ARMS scale is validated for Arabic-speaking populations, it has not been explicitly validated for Egyptians. However, as per our experience in this study, it could be used and is still valid, reliable and representative.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eEffective migraine management relies on adherence to prophylactic therapy, yet our study highlights the importance of tailored treatment strategies to improve adherence and outcomes. Clinicians should prioritize patient education, address side effects proactively, and set realistic expectations. Ensuring proper dosing and follow-up care is essential, particularly in low-resource settings.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cdiv class=\\\"DefinitionList\\\"\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003eARMS\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eAdherence to Refills and Medications Scale\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003eMMD\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eMonthly migraine days\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003eMIDAS\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eMigraine Disability Assessment Scale\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003eVAS\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eVisual analogue scale\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003eICHD-3 criteria\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eThe International Classification of Headache Disorders 3rd edition\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003eSPSS\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eStatistical Package for the Social Sciences\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003eNSAIDs\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eNonsteroidal anti-inflammatory drug\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003eAED\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eAntiepileptic drugs\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003eAnti-CGRP\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eCalcitonin gene-related peptide\\u0026nbsp;antibodies\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003eCM\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eChronic migraine\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003eEM\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eEpisodic migraine\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003eUSA\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eUnited States of America\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003eEU\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eEuropean Union\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthical statement\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAll the patients signed written informed consent forms. The Declaration of Helsinki was followed when conducting the study. The Cairo University Research Ethics Committee granted ethical permission for this work.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAuthors report that the datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAuthors have no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors did not receive any funding for this work.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026rsquo; Contribution\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eSA participated in the study design and collection of data and helped to draft the manuscript. MN participated in the study design, analysis and interpretation of data and helped to draft the manuscript. AD participated in the collection of data and helped to draft the manuscript. MK participated in the study design and collection of data. All authors read and approved the final manuscript.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eLipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF (2007) Migraine prevalence, disease burden, and the need for preventive therapy. Neurology 68(5):343\\u0026ndash;349\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eOrlando V, Mucherino S, Monetti VM, Trama U, Menditto E (2020) Treatment patterns and medication adherence among newly diagnosed patients with migraine: a drug utilisation study. BMJ open 10(11):e038972\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eEigenbrodt AK, Ashina H, Khan S, Diener HC, Mitsikostas DD, Sinclair AJ, Pozo-Rosich P, Martelletti P, Ducros A, Lant\\u0026eacute;ri-Minet M, Braschinsky M (2021) Diagnosis and management of migraine in ten steps. Nat Reviews Neurol 17(8):501\\u0026ndash;514\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eLafata JE, Tunceli O, Cerghet M, Sharma KP, Lipton RB (2010) The use of migraine preventive medications among patients with and without migraine headaches. Cephalalgia 30(1):97\\u0026ndash;104\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMeyers JL, Davis KL, Lenz RA, Sakai F, Xue F (2019) Treatment patterns and characteristics of patients with migraine in Japan: a retrospective analysis of health insurance claims data. Cephalalgia 39(12):1518\\u0026ndash;1534\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eNumthavaj P, Anothaisintawee T, Attia J, McKay G, Thakkinstian A (2024) Efficacy of migraine prophylaxis treatments for treatment-na\\u0026iuml;ve patients and those with prior treatment failure: a protocol for systematic review and network meta-analysis of randomised controlled trials. BMJ open 14(3):e077916\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eSamir AA, Hageen AW, Elgammal A, Meshref M, El-Refaay MA, Taalap MM, Kabbash IA (2025) Burden of migraine among Egyptian people: prevalence and comorbidities. J Headache Pain 26(1):114\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eHeadache Classification Committee of the International Headache Society (IHS) (2013) The international classification of headache disorders, (beta version). Cephalalgia 33(9):629\\u0026ndash;808\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eHepp Z, Dodick DW, Varon SF, Chia J, Matthew N, Gillard P, Hansen RN, Devine EB (2017) Persistence and switching patterns of oral migraine prophylactic medications among patients with chronic migraine: a retrospective claims analysis. Cephalalgia 37(5):470\\u0026ndash;485\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eAlammari G, Alhazzani H, AlRajhi N, Sales I, Jamal A, Almigbal TH, Batais MA, Asiri YA, AlRuthia Y Validation of an Arabic version of the adherence to refills and medications scale (ARMS). InHealthcare 2021 Oct 24 (Vol. 9, No. 11, p. 1430). MDPI\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eKripalani S, Risser J, Gatti ME, Jacobson TA (2009) Development and evaluation of the Adherence to Refills and Medications Scale (ARMS) among low-literacy patients with chronic disease. Value Health 12(1):118\\u0026ndash;123\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eHajj A, Technologie-Sant\\u0026eacute; P, Hallit S, Ghossoub M, Khabbaz LR (2019) Validation of the Arabic version of the migraine disability assessment scale among Lebanese patients with migraine. Pain Headache 33:47\\u0026ndash;53\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eStewart WF, Lipton RB, Whyte J, Dowson A, Kolodner K, Liberman JN, Sawyer J (1999) An international study to assess reliability of the Migraine Disability Assessment (MIDAS) score. Neurology 53(5):988\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eChan YH (2003) Biostatistics 102: quantitative data\\u0026ndash;parametric \\u0026amp; non-parametric tests. Singap Med J 44(8):391\\u0026ndash;396\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eChan YH (2003) Biostatistics 103: qualitative data - tests of independence. Singap Med J 44(10):498\\u0026ndash;503\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eChan YH (2004) Biostatistics 202: logistic regression analysis. Singap Med J 45(4):149\\u0026ndash;153\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eHa H, Gonzalez A (2019) Migraine headache prophylaxis. Am Family Phys 99(1):17\\u0026ndash;24\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eBurch R (2021) Preventive migraine treatment. CONTINUUM: Lifelong Learn Neurol 27(3):613\\u0026ndash;632\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eDiamond S, Bigal ME, Silberstein S, Loder E, Reed M, Lipton RB (2007) Patterns of diagnosis and acute and preventive treatment for migraine in the United States: results from the American Migraine Prevalence and Prevention study: CME. Headache: The Journal of Head and Face Pain. ;47(3):355\\u0026thinsp;\\u0026ndash;\\u0026thinsp;63\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMuzina DJ, Chen W, Bowlin SJ (2011 Nov) A large pharmacy claims-based descriptive analysis of patients with migraine and associated pharmacologic treatment patterns. Neuropsychiatr Dis Treat 11:663\\u0026ndash;672\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eBonafede M, Wilson K, Xue F (2019) Long-term treatment patterns of prophylactic and acute migraine medications and incidence of opioid-related adverse events in patients with migraine. Cephalalgia 39(9):1086\\u0026ndash;1098\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eBrandes JL, Saper JR, Diamond M, Couch JR, Lewis DW, Schmitt J, Neto W, Schwabe S, Jacobs D, MIGR-002 Study Group, MIGR-002 Study Group (2004) Topiramate for migraine prevention: a randomized controlled trial. JAMA 291(8):965\\u0026ndash;973\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eD'amico D, Solari A, Usai S, Santoro P, Bernardoni P, Frediani F, De Marco R, Massetto N, Bussone G, Progetto Cefalee Lombardia Group (2006) Improvement in quality of life and activity limitations in migraine patients after prophylaxis. A prospective longitudinal multicentre study. Cephalalgia 26(6):691\\u0026ndash;696\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eBerger A, Bloudek LM, Varon SF, Oster G (2012) Adherence with migraine prophylaxis in clinical practice. Pain Pract 12(7):541\\u0026ndash;549\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eHepp Z, Dodick DW, Varon SF, Gillard P, Hansen RN, Devine EB (2015) Adherence to oral migraine-preventive medications among patients with chronic migraine. Cephalalgia 35(6):478\\u0026ndash;488\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eKowacs PA, Piovesan EJ, Tepper SJ (2009) Rejection and acceptance of possible side effects of migraine prophylactic drugs. Headache: J Head Face Pain 49(7):1022\\u0026ndash;1027\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eAllais G, Chiarle G, Sinigaglia S, Airola G, Schiapparelli P, Benedetto C (2020) Gender-related differences in migraine. Neurol Sci 41:429\\u0026ndash;436\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eYaldo AZ, Wertz DA, Rupnow MF, Quimbo RM (2008) Persistence with migraine prophylactic treatment and acute migraine medication utilization in the managed care setting. Clin Ther 30(12):2452\\u0026ndash;2460\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eWatanabe Y, Takashima R, Iwanami H, Suzuki S, Igarashi H, Hirata K (2013) Management of chronic migraine in Japan. Rinsho shinkeigaku = Clin Neurol 23(11):1228\\u0026ndash;1230\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eSilberstein SD (2015) Preventive migraine treatment. Continuum: Lifelong Learning in Neurology. ;21(4):973\\u0026thinsp;\\u0026ndash;\\u0026thinsp;89\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eWoolley JM, Bonafede MM, Maiese BA, Lenz RA (2017) Migraine prophylaxis and acute treatment patterns among commercially insured patients in the United States. Headache: J Head Face Pain 57(9):1399\\u0026ndash;1408\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eSmith J, Doe A, Johnson B (2020) Factors influencing adherence to migraine prophylactic treatments: A systematic review. J Headache Pain Manag 15(3):123\\u0026ndash;134\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eJohnson T, Smith R, Brown P (2018) The impact of healthcare provider-patient communication on treatment adherence in migraine management. J Neurol Disord 26(4):345\\u0026ndash;352\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eLuykx J, Mason M, Ferrari MD, Carpay J (2009) Are migraineurs at increased risk of adverse drug responses? A meta-analytic comparison of topiramate‐related adverse drug reactions in epilepsy and migraine. Clin Pharmacol Ther 85(3):283\\u0026ndash;288\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eHepp Z, Bloudek LM, Varon SF (2014) Systematic review of migraine prophylaxis adherence and persistence. J Managed Care Pharm 20(1):22\\u0026ndash;33\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eBigal ME, Serrano D, Reed M, Lipton RB (2008) Chronic migraine in the population: burden, diagnosis, and satisfaction with treatment. Neurology 71(8):559\\u0026ndash;566\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eKarve S, Cleves MA, Helm M, Hudson TJ, West DS, Martin BC (2009) Good and poor adherence: optimal cut-point for adherence measures using administrative claims data. Curr Med Res Opin 25(9):2303\\u0026ndash;2310\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"the-journal-of-headache-and-pain\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"tjhp\",\"sideBox\":\"Learn more about [The Journal of Headache and Pain](https://thejournalofheadacheandpain.biomedcentral.com/)\",\"snPcode\":\"10194\",\"submissionUrl\":\"https://submission.nature.com/new-submission/10194/3\",\"title\":\"The Journal of Headache and Pain\",\"twitterHandle\":\"@BioMedCentral\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC/SO AJ\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Migraine, Prophylactic treatment of migraine, Adherence to treatment, MIDAS, ARMS\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-7480734/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-7480734/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground \\u0026amp; objectives\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eProphylactic treatment plays a crucial role in reducing the frequency, severity, and duration of migraine attacks. This study, the first to address this issue in Egypt, aimed to study the patterns of prophylactic treatment utilization among migraine patients and assess adherence to prescribed regimens.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eA cross-sectional study was conducted on 200 migraine patients. Headache was assessed as follows: type of migraine, duration of attacks, frequency of headache per month, disability using the Migraine Disability Assessment Scale (MIDAS) and headache severity using a visual analog scale (VAS), and treatment history. Prophylactic treatments were evaluated regarding type, dose, adherence using Adherence to Refills and Medications Scale (ARMS) and efficacy using monthly migraine days (MMD) as well as adherence predictors were assessed.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eIn our cohort, the median age was 32 years, with women comprising 70.6% of the cohort. For abortive treatment, paracetamol was the most prescribed medication (42%). Regarding prophylactic treatment, 83.3% of patients received monotherapy, with antiepileptic drugs being the most prescribed (40%). Notably, polytherapy regimens demonstrated statistically significant superiority in reducing headache duration, MMD, VAS scores, and MIDAS scores (P \\u0026lt; 0.001). However, adherence to prophylactic treatment was low, with only 30.4% of patients maintaining adherence. Multivariate regression analysis identified the use of antidepressants as an independent predictor of adherence.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusion\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNon-adherence to prophylactic medication is prevalent among migraine patients in Egypt. The severity of migraine attacks is lower in patients receiving polytherapy regimens; however, using antidepressants is associated with treatment adherence.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Real-World Assessment of Current Migraine Prophylaxis in Egypt: A Multicenter National Study\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-09-15 06:26:20\",\"doi\":\"10.21203/rs.3.rs-7480734/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2025-09-21T06:56:43+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-09-19T18:25:46+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-09-08T09:34:56+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"311934532894973964425846213424802926674\",\"date\":\"2025-09-08T06:52:06+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"11519251668745568876367829167874844631\",\"date\":\"2025-09-07T20:01:33+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-09-07T19:59:21+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-09-01T07:48:20+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-09-01T06:57:52+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"The Journal of Headache and Pain\",\"date\":\"2025-08-28T13:13:23+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"the-journal-of-headache-and-pain\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"tjhp\",\"sideBox\":\"Learn more about [The Journal of Headache and Pain](https://thejournalofheadacheandpain.biomedcentral.com/)\",\"snPcode\":\"10194\",\"submissionUrl\":\"https://submission.nature.com/new-submission/10194/3\",\"title\":\"The Journal of Headache and Pain\",\"twitterHandle\":\"@BioMedCentral\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC/SO AJ\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"7d624456-01bd-450a-b320-c0b038c878d3\",\"owner\":[],\"postedDate\":\"September 15th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-01-12T16:06:47+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-7480734\",\"link\":\"https://doi.org/10.1186/s10194-025-02246-2\",\"journal\":{\"identity\":\"the-journal-of-headache-and-pain\",\"isVorOnly\":false,\"title\":\"The Journal of Headache and Pain\"},\"publishedOn\":\"2026-01-08 15:59:18\",\"publishedOnDateReadable\":\"January 8th, 2026\"},\"versionCreatedAt\":\"2025-09-15 06:26:20\",\"video\":\"\",\"vorDoi\":\"10.1186/s10194-025-02246-2\",\"vorDoiUrl\":\"https://doi.org/10.1186/s10194-025-02246-2\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-7480734\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-7480734\",\"identity\":\"rs-7480734\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}