Migraine treatment experience in Denmark: results from the nationwide DREAM study with 58000 respondents

Background Acute migraine treatment effectiveness is often assessed using two hour pain outcomes, but these do not fully capture sustained symptom control, functional recovery, or tolerability. We therefore investigated treatment response in Denmark using a broader definition of effective treatment and examined sex differences in outcomes. Methods The DREAM study is a nationwide survey linked at the individual level to Danish health and socioeconomic registers, including adults with triptan redemption and/or a hospital-recorded migraine diagnosis. Analyses were restricted to respondents with self-reported physician-diagnosed migraine and at least one migraine attack within the previous three months. Treatment response for the most recent attack was assessed using an approximation of the effective treatment definition proposed by a European Headache Federation Consensus Panel, adapted to the available survey items. We also assessed pain relief and return to normal function within two hours. Results Of 145333 invited individuals, 58606 completed the survey. Among these, 50857 reported physician-diagnosed migraine, and 41498 reported at least one migraine attack within the previous three months treated with either simple analgesics, triptans or other treatments. Due to skip logic, questions used to define effective treatment were answered by 38981 respondents, of whom 14021 (36.0%) met the criterion of effective treatment, while 29001 (74.4%) reported pain relief within two hours and 13856 (35.5%) reported return to normal function within two hours. In the unadjusted descriptive analyses, lower proportions of women than men met the criterion for effective treatment (34.2% vs. 45.4%), reported pain relief within two hours (73.6% vs. 78.8%), and reported a return to normal function within two hours (34.5% vs. 41.3%); these differences should not be interpreted as an independent effect of sex. Conclusions In this large nationwide study, only one in three individuals with migraine met a broader criterion for effective treatment of their most recent migraine attack, despite nearly three-quarters reporting two hour pain relief. Women reported poorer outcomes across all treatment endpoints. These findings suggest a considerable unmet need in acute migraine care and highlight the importance of evaluating treatment success beyond early pain relief alone.