{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T12:19:28Z","timestamp":1793103568281,"version":"4.5.0"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2021,3,26]],"date-time":"2021-03-26T00:00:00Z","timestamp":1616716800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Reckett Benckiser"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>The persistence pattern of anti-migraine drugs\u2019 use among migraineurs is very low in the United States and different European countries. However, the cost and persistence of antimigraine drugs in Asian countries have not been well-studied. Hence, the present study aimed to evaluate the treatment cost and persistence among migraineurs in Pakistan.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Data from prescriptions collected from migraineurs who visited the Outpatient Department (OPD) of different public and private sector tertiary-care hospitals of Karachi, Pakistan were used to conduct this retrospective cohort study from 2017 to 2019. The minimum follow up period for each migraineur was about 12 months for persistence analysis while dropped-out patients data were also included in survival analysis as right censored data. Pairwise comparisons from Cox regression\/hazards ratio were used to assess the predictors of persistence with the reference category of non-binary variables i.e. hazard ratio = 1 for low frequency migraineurs and NSAIDs users. Persistence with anti-migraine drugs was estimated using the Kaplan-Meier curve along with the Log Rank test.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 1597 patients were included in this study, 729 (45.6%) were male and 868 (54.3%) were female. Non-steroidal anti-inflammatory drugs (NSAIDs) were the most prescribed class of drug initially for all classes of migraineurs (26.1%). Of them, 57.3% of migraineurs discontinued their treatment, 28.5% continued while 14.8% were switched to other treatment approaches. Persistence with initial treatment was more profound in female (58.8%) patients compared to males while the median age of continuers was 31 years. The total cost of migraine treatment in the entire study cohort was 297532.5 Pakistani Rupees ($1901.1). By estimating the hazard ratios (HR) using the Cox regression analysis, it can be observed that patients with high frequency (HR, 1.628; 95%CI, 1.221\u20132.179; <jats:italic>p&lt;0<\/jats:italic>.<jats:italic>0001<\/jats:italic>) migraine, depression (HR, 1.268; 95%CI, 1.084\u20131.458; <jats:italic>p&lt;0<\/jats:italic>.<jats:italic>0001<\/jats:italic>), increasing age (HR, 1.293; 95%CI, 1.092\u20131.458; <jats:italic>p&lt;0<\/jats:italic>.<jats:italic>0001<\/jats:italic>), combination analgesics (HR, 1.817; 95%CI, 0.841\u20132.725; <jats:italic>p = 0<\/jats:italic>.<jats:italic>0004<\/jats:italic>) and prophylaxis drugs (HR, 1.314; 95%CI, 0.958\u20131.424; <jats:italic>p&lt;0<\/jats:italic>.<jats:italic>0001<\/jats:italic>) users were at a higher risk of treatment discontinuation. However, patients with chronic migraine (HR, 0.881; 95%CI, 0.762\u20130.912; <jats:italic>p = 0<\/jats:italic>.<jats:italic>0002<\/jats:italic>), epileptic seizure (HR, 0.922; 95%CI, 0.654\u20131.206; <jats:italic>p = 0<\/jats:italic>.<jats:italic>0002<\/jats:italic>), other comorbidities (HR, 0.671; 95%CI, 0.352\u20131.011; <jats:italic>p = 0<\/jats:italic>.<jats:italic>0003<\/jats:italic>) and users of triptan(s) (HR, 0.701; 95%CI, 0.182\u20131.414; <jats:italic>p = 0<\/jats:italic>.<jats:italic>0005<\/jats:italic>) and triptan(s) with NSAIDs (HR, 0.758; 95%CI, 0.501\u20131.289; <jats:italic>p&lt;0<\/jats:italic>.<jats:italic>0001<\/jats:italic>) had more chances to continue their initial therapy.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Similar to western countries, the majority of migraineurs exhibited poor persistence to migraine treatments. Various factors of improved persistence were identified in this study.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0248761","type":"journal-article","created":{"date-parts":[[2021,3,26]],"date-time":"2021-03-26T17:33:25Z","timestamp":1616780005000},"page":"e0248761","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Analysis of treatment cost and persistence among migraineurs: A two-year retrospective cohort study in Pakistan"],"prefix":"10.1371","volume":"16","author":[{"given":"Kamran","family":"Khan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mudassar Iqbal","family":"Arain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3220-8418","authenticated-orcid":true,"given":"Muhammad Arif","family":"Asghar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahad Abdul","family":"Rehman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Ali","family":"Ghoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Dayo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Suleman","family":"Imtiaz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohsin Hamied","family":"Rana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Asif","family":"Asghar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,3,26]]},"reference":[{"key":"pone.0248761.ref001","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1111\/head.12404","article-title":"Treatment persistence and switching in triptan users: a systematic literature review.","volume":"54","author":"AJ Messali","year":"2014","journal-title":"Headache: J Head Face Pain."},{"key":"pone.0248761.ref002","doi-asserted-by":"crossref","first-page":"117","DOI":"10.2217\/pmt-2019-0057","article-title":"Nonprescription drugs recommended in guidelines for common pain conditions","volume":"10","author":"M Hagen","year":"2020","journal-title":"Pain Manag."},{"key":"pone.0248761.ref003","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1016\/S1474-4422(18)30322-3","article-title":"Global, regional, and national burden of migraine and tension-type headache, 1990\u20132016: a systematic analysis for the Global Burden of Disease Study 2016","volume":"17","author":"LJ Stovner","year":"2018","journal-title":"Lancet Neurol"},{"key":"pone.0248761.ref004","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1186\/1129-2377-14-73","article-title":"The burden of headache disorders in Pakistan: methodology of a population-based nationwide study, and questionnaire validation","volume":"14","author":"AD Herekar","year":"2013","journal-title":"J Headache Pain"},{"key":"pone.0248761.ref005","doi-asserted-by":"crossref","first-page":"793","DOI":"10.2165\/00002512-200421120-00004","article-title":"Medication non-adherence in the elderly.","volume":"21","author":"CM Hughes","year":"2004","journal-title":"Drugs & aging"},{"key":"pone.0248761.ref006","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1001\/archinte.159.8.813","article-title":"Burden of migraine in the United States: disability and economic costs","volume":"159","author":"XH Hu","year":"1999","journal-title":"Arch Intern Med"},{"key":"pone.0248761.ref007","doi-asserted-by":"crossref","first-page":"170","DOI":"10.5847\/wjem.j.1920-8642.2017.03.002","article-title":"The presenting and prescribing patterns of migraine in an Australian emergency department: A descriptive exploratory study.","volume":"8","author":"E Shao","year":"2017","journal-title":"World J Emerg Med"},{"key":"pone.0248761.ref008","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1177\/0333102416678382","article-title":"Persistence and switching patterns of oral migraine prophylactic medications among patients with chronic migraine: a retrospective claims analysis.","volume":"37","author":"Z Hepp","year":"2017","journal-title":"Cephalalgia"},{"key":"pone.0248761.ref009","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1111\/head.13157","article-title":"Migraine prophylaxis and acute treatment patterns among commercially insured patients in the United States. 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study","volume":"20","author":"F Hjalte","year":"2019","journal-title":"J Headache Pain"},{"key":"pone.0248761.ref013","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1111\/ene.14034","article-title":"The cost and the value of treatment of medication overuse headache in Italy: a longitudinal study based on patient\u2010derived data","volume":"27","author":"A Raggi","journal-title":"Euro J Neurol. 2020"},{"key":"pone.0248761.ref014","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1177\/0333102414547138","article-title":"Adherence to oral migraine-preventive medications among patients with chronic migraine.","volume":"35","author":"Z Hepp","year":"2015","journal-title":"Cephalalgia"},{"key":"pone.0248761.ref015","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1186\/1129-2377-15-48","article-title":"Treatment adherence among new triptan users: a 2-year cohort study in Taiwan.","volume":"15","author":"T-B Chen","year":"2014","journal-title":"J Headache 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classification of headache disorders, (beta version).","volume":"33","author":"HC Society","year":"2013","journal-title":"Cephalalgia"},{"key":"pone.0248761.ref020","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1186\/s10194-018-0951-2","article-title":"Preventive effects of galcanezumab in adult patients with episodic or chronic migraine are persistent: data from the phase 3, randomized, double-blind, placebo-controlled EVOLVE-1, EVOLVE-2, and REGAIN studies","volume":"19","author":"S F\u00f6rderreuther","year":"2018","journal-title":"J Headache Pain"},{"key":"pone.0248761.ref021","first-page":"157","article-title":"Facilitating and Improving Adherence: The Development of a Pulmonary Arterial Hypertension Self-Care Management Agreement.","volume":"53","author":"M Troy","year":"2019","journal-title":"Advan Pulmon Hyper"},{"key":"pone.0248761.ref022","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1111\/head.13089","article-title":"The diagnosis and management of chronic migraine in primary care.","volume":"57","author":"WJ Becker","year":"2017","journal-title":"Headache: J Head Face Pain."},{"key":"pone.0248761.ref023","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/978-3-319-91491-6_15","article-title":"Optimizing Acute Headache Treatment in the Setting of Chronic Migraine.","author":"A Tinsley","year":"2019","journal-title":"Chronic Headache: Springer."},{"key":"pone.0248761.ref024","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1111\/j.1526-4610.2007.00754.x","article-title":"Topiramate in migraine prophylaxis: Long\u2010term impact on resource utilization and cost.","volume":"47","author":"SD Silberstein","year":"2007","journal-title":"Headache: J Head Face Pain."},{"key":"pone.0248761.ref025","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1056\/NEJMct0910887","article-title":"Triptan therapy in migraine.","volume":"363","author":"E Loder","year":"2010","journal-title":"New Eng J Med"},{"key":"pone.0248761.ref026","first-page":"63","article-title":"Adherence and persistence with branded antidepressants and generic SSRIs among managed care patients with major depressive disorder.","volume":"3","author":"X Liu","year":"2011","journal-title":"ClinicoEconomics and outcomes research: CEOR."},{"key":"pone.0248761.ref027","doi-asserted-by":"crossref","first-page":"137","DOI":"10.18553\/jmcp.2005.11.2.137","article-title":"Costs and utilization of triptan users who receive drug prophylaxis for migraine versus triptan users who do not receive drug prophylaxis","volume":"11","author":"LR Etemad","year":"2005","journal-title":"Journal of Managed Care Pharmacy"},{"key":"pone.0248761.ref028","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1212\/01.wnl.0000225186.76323.69","article-title":"Age-dependent prevalence and clinical features of migraine.","volume":"67","author":"ME Bigal","year":"2006","journal-title":"Neurol"},{"key":"pone.0248761.ref029","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/S1474-4422(04)00824-5","article-title":"Medication-overuse headache: a worldwide problem","volume":"3","author":"H-C Diener","year":"2004","journal-title":"The Lancet Neurol"},{"key":"pone.0248761.ref030","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1046\/j.1526-4610.2000.00148.x","article-title":"Comorbidity of depressive and anxiety disorders in chronic daily headache and its subtypes.","volume":"40","author":"KD Juang","year":"2000","journal-title":"Headache: J Head Face Pain"},{"key":"pone.0248761.ref031","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s10072-009-0071-5","article-title":"Migraine and psychiatric disorders: comorbidities, mechanisms, and clinical applications.","volume":"30","author":"S Baskin","year":"2009","journal-title":"Neurol Sci."},{"key":"pone.0248761.ref032","doi-asserted-by":"crossref","first-page":"22","DOI":"10.18553\/jmcp.2014.20.1.22","article-title":"Systematic review of migraine prophylaxis adherence and persistence.","volume":"20","author":"Z Hepp","year":"2014","journal-title":"J Manag Care Pharm"},{"key":"pone.0248761.ref033","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1177\/0333102412449929","article-title":"Results of a 2-year retrospective cohort study of newly prescribed triptan users in European nationwide practice databases.","volume":"32","author":"DS Ng-Mak","year":"2012","journal-title":"Cephalalgia"},{"key":"pone.0248761.ref034","doi-asserted-by":"crossref","first-page":"1651","DOI":"10.1111\/head.12233","article-title":"Choosing Wisely in Headache Medicine: The A merican Headache Society\u2019s List of Five Things Physicians and Patients Should Question.","volume":"53","author":"E Loder","year":"2013","journal-title":"Headache: J Head Face 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