MAST Study Identifies Most Bothersome Symptom (MBS) for Patients with Migraine

Photophobia topped the list and Nausea more likely to be reported as MBS for women

Among nausea, phonophobia, and photophobia, one of these symptoms are reported as the most bothersome symptoms (MBS) in individuals with migraine. For the first time, the baseline information on MBS was collected in a cross-sectional, observational Migraine in America Symptoms and Treatment (MAST) study. While patient profiles differed among the groups defined by their MBS, the most common MBS was photophobia.

These findings were published in a recent issue of Headache®. The results, says Sagar Munjal, MD, MS, vice president of Dr. Reddy’s Laboratories and lead author of the paper, are consistent with results published in clinical trials. Researchers have known for a few years that photophobia is the most commonly reported MBS overall, but the overall prevalence was not well-established. Dr. Munjal and his authors found that most women report nausea as the most bothersome symptom. The prevalence of MBS symptoms for migraineurs was not reported previously nor was the gender difference and some of the demographic variability reported previously.

Data for a new endpoint

The MBS has emerged as an important co-primary efficacy endpoint in clinical trials of acute treatments for migraine trials, per the FDA guidance. The goal of the paper, Dr. Munjal says, is “to establish a baseline for the MBS prevalence—a symptom which will help to understand this clinical endpoint from a clinical trial perspective—as well to enhance the knowledge and get more data on the MBS endpoint.” 

The cross-sectional, observational 2017 MAST study recruited adults 18 and older from a nationwide U.S. online research panel for a survey that ascertained sociodemographic variables, headache-related disability, monthly headache days, anxiety and depression symptoms, visual aura, and acute treatment optimization, among other symptoms. Dr. Munjal and his co-authors’ analysis was based on respondents who also completed a 6-month follow-up assessment that included questions about their most bothersome symptom. 

“Typically, two-thirds of the subjects would experience all three—photophobia, phonophobia and nausea—as the MBS at some point,” says Dr. Munjal. “Somebody who reports photophobia as the most bothersome in a few weeks or few months may say, ‘Now nausea is my most bothersome (symptom).’” Of the top three MBS, 49.1% of patients reported photophobia as the most bothersome symptom. “Additional evaluation is required whenever a patient is coming to the clinic in order to understand, other than pain, which symptoms are the most bothersome,” says Dr. Munjal.

Most Bothersome Symptom vs. pain 

Further research on MBS, Dr. Munjal says, will help patients with better migraine management objectives. “The focus used to be only on pain, so patients used to get mostly pain medication such as NSAIDs or triptans. However, for better outcomes along with pain the MBS and the cardinal symptoms also need to be managed adequately.”

Dr. Munjal explains the next logical step on the subject would be a longitudinal follow up to track symptoms over one or two years to see how they change. “Is there a correlation between season, or some particular stimulus where one MBS symptom prevails over the other MBS symptom?” he asks. Clinical trials can evaluate drug performance and determine which MBS symptom responds to which class of the drug. 

“There are three or four ways to address this, and every approach will answer a different question,” Dr. Munjal says. “The field is evolving and progressing.”

Headache®: The Journal of Head and Face Pain is the official journal of the American Headache Society. AHS frequently reviews published research and provides commentary on the work being done to help advance the understanding of headache and face pain. For more analysis on studies published in Headache®, visit the AHS News page.