Expert Insights in Neurology: Dawn Buse, PhD, on the OVERCOME Study

In this video, Dr Buse discusses the findings of the OVERCOME Study, in which she and her colleagues investigated the influence of acute treatment optimization on disability and health-related quality of life among people with migraine. This study was featured in the 2020 American Academy of Neurology Science Highlights. 

Additional Resources:

  1. Buse D, Kovacik AJ, Nicholson RA, et al. Acute Treatment Optimization Influences Disability and Quality of Life in Migraine: Results of the ObserVational survey of the Epidemiology, tReatment and Care Of MigrainE (OVERCOME) Study. Neurology. 2020;94(15 suppl.).
  2. Neurology Consultant.

Dawn Buse, PhD, is a clinical professor of neurology at Albert Einstein College of Medicine in Bronx, New York, and a member of the Board of Directors of the American Headache Society.


Dr Buse: I'm Dawn Buse, and today I’m presenting the results of “Acute Treatment Optimization Influences Disability and Quality of Life in Migraine: Results of the OVERCOME Study.” This is an abstract that we're presenting at the American Academy of Neurology this year (2020) and of course, these are all virtual presentations this year. And OVERCOME Study stands for “ObserVational survey of the Epidemiology, tReatment and Care Of MigrainE.” And I’m presenting this on behalf of my co-authors Amy Kovacik, Robert Nicholson, Erin Doty, Andre Araujo, Sait Ashina, Michael Reed, Robert Shapiro, Yongin Kim, and Richard Lipton. And again, I'm Dawn Buse, and I'm a clinical professor of neurology at Albert Einstein College of Medicine in the Bronx, as well as a member of the Board of Directors of the American Headache Society.

So, we all know that acute treatment optimization is considered optimized when it does 2 things: relieves pain and restores function. And we tend to think of the benefits of acute treatment being quite acute or time-limited, but my co-authors and I wanted to know, do those benefits extend longer-lasting into the future? And so, we wanted to look at, does acute treatment optimization affect disability and does it affect quality of life in people with migraine? We also wanted to look at changes in acute treatment optimization, disability, and quality of life in subdivisions of headache days. So, we divided our sample into people with 0 to 3 headache days per month on average, 4 to 7, 8 to 14, or 15 or more.

So, as I mentioned, these data were obtained from the OVERCOME Study, which is a web-based survey which has been conducted in a representative sample of US population participants, and these are data from Cohort 1 Wave 1, or our baseline survey. We have multiple cohorts and multiple waves in our longitudinal study, but these are really the baseline–Cohort 1 Wave 1. They were collected in Fall of 2018, and we asked people if they either had received a diagnosis of migraine from a health care professional, and/or they could meet criteria for migraine using ICHD-3 criteria, which we assessed with the American Migraine Study AMPP Diagnostic Module, which is a validated screener for migraine.

So, of that group, we had about 20,000 people–20,041 to be precise. That was 95% of our sample, and we looked at several measures. We looked at the acute Migraine Treatment Optimization Questionnaire [mTOQ], the 4-item version where we sum the scores, and it comes out to 4 categories: 0 being very poor, 1 to 5 being poor treatment optimization, 6 to 7 being moderate treatment optimization, and 8 being maximal treatment optimization. We also included the Migraine-Related Disability Scale (the MIDAS), which also is a sum score with 0 to 5 being little or none, 6 to 10 being mild, 11 to 20 being moderate, and 21 or more being severe headache-related disability. And we also used the role function-restrictive subscale of the Migraine-Specific Quality of Life–so, the MSQ roll function-restrictive subscale.

So, one important thing to keep in mind as I share the results is that there's opposite balances on some of these. So, in our treatment optimization questionnaire, the mTOQ, higher scores are better (more optimization, better optimized), as well as in the MSQ, higher scores are better (better quality of life), whereas in the MIDAS, higher scores, indicate greater disability. So, we've got things going in 2 directions. So, I'll just keep that in mind as I explain the results.

So, we did statistical analyses, either one-way ANOVAs or Chi squares as appropriate, in our monthly headache day groups, and then we looked to explore the relationship between treatment optimization, the MIDAS and the MSQ roll function-restrictive to see how these all traveled together or didn’t.

So, in our results, over half of the respondents had poor or very poor acute treatment optimization. So, just as a snapshot of how people in the US are doing with their current acute treatment, anything that they use–OTC, prescription, any combination they use–over half of them are not currently optimized, and the questions about optimization (the mTOQ) include things like:

  • “Are you pain-free at 2 hours?”
  • “Do you stay pain-free for 24 hours if you obtain pain freedom?”
  • “Do you feel like you can plan your day and conduct your usual daily activities?” and
  • “If there are side effects, are they tolerable?”

So, when we think about that, less than half the people–20,000 people in the US who answered this–had very poor or poor acute treatment optimization, so that's not a great place we’re starting from. And then, we wanted to see again, … does that have a relationship with longer term global migraine-related disability and migraine-related quality of life, and we found yes, it did. Everything really traveled in the expected relationship or the hypothesized direction. So, disability–the MIDAS–increased with decreased treatment optimizations. Those are the ones that went opposite directions. So, increased disability was just associated with decreased treatment optimization, and that increased in a stepwise gradient across those monthly headache day groups, of course. So, someone with lower monthly headache day group had less disability, and someone in the highest of course had more disability, but we saw that that relationship stayed true across those headache day categories, and all of them were affected by the relationship between treatment optimization and migraine-related disability.

And we also asked a question about, “how does your usual migraine affect you, from no impact at all to bedrest required?” We saw this also traveled with acute treatment optimization, and then also in the role function-restrictive subscale of the Migraine-Specific Quality of Life, we did see that, as treatment optimization was higher, so was migraine related quality of life. So, I think that, taken together, these findings show us that optimizing acute treatment has benefits beyond just that specific attack. And this is certainly logical. When a patient feels in control or confident of the management of their migraine, they may feel more able to plan or execute activities in their daily life, leading to less disability, leading to improved quality of life, and possibly leading to other positive outcomes.

So certainly, we want health care professionals to think about optimizing acute treatment, and they may even want to think about asking a question about it in in follow-up if they don't already or even including a validated instrument, if that's helpful for measuring acute treatment optimization. The mTOC is available for use in the public domain, free of charge. So that's an option, but certainly something to keep in mind, and we hope that these results will illuminate the importance of optimizing acute treatment optimization, as well as remind folks to think about the whole spectrum of treatment that can help migraine, all the way from the important lifestyle education to acute treatments, be they pharmacologic or neurostimulation, to preventive treatments, be they pharmacologic, neurostimulation, or behavioral, and really thinking about how to combine those in a tailored, optimized approach for each patient to help each person with migraine achieve the best outcomes.

Thank you for allowing me to share these findings with you today.