Patients’ Values and Preferences Regarding the Pharmacologic Treatment of Acute Episodic Migraine

Understanding patients' values and preferences is essential for guideline development. To identify and synthesize evidence on patients' values and preferences for the American College of Physicians (ACP) clinical guideline on the pharmacologic treatment of acute attacks of episodic migraine. MEDLINE (Ovid) and CINAHL (EBSCO) were searched from inception to October 2024, and backward citation searches on pertinent publications were performed. Reviewers dually screened abstracts and articles. One reviewer performed data extraction, and a second team member checked for accuracy. Risk of bias was assessed in the included studies dually. The data were synthesized narratively and the certainty of evidence (COE) was assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation) and GRADE-CERQual (GRADE-Confidence in the Evidence from Reviews of Qualitative Research) guidance. Of 2243 references screened, we included 16 quantitative studies and 1 qualitative study. Effectiveness for pain was rated as more important than avoiding harms (moderate COE) or treating accompanying symptoms (moderate COE). Both effectiveness for pain and avoiding harms were more important than other attributes such as convenience or route of administration (moderate COE). Relieving nausea and vomiting was more important than other accompanying symptoms, such as photophobia (moderate COE). Cost was not important (moderate COE). The choices in the included studies differed, making synthesis difficult and reducing certainty. Generalizability is limited because the included studies span 29 years and included patients of average age 35 to 47 years. Potential variation between patients was not captured. Patients value effectiveness for pain foremost, and avoiding harm is more important than other treatment attributes. American College of Physicians. (PROSPERO: CRD42023464889).