A Systematic Literature Review of Preference Studies in Migraine Treatments.

Abstract

Background: Migraine care is often suboptimal owing to undertreatment, variation in clinical outcomes and administration methods among existing treatments, and between- and within-individual heterogeneity in the clinical course of migraine. In response to these challenges, preference studies have been increasingly conducted to inform treatment decision-making and development. However, gaps remain in understanding how treatment preferences have been assessed across different migraine studies.

Objective: The aim was to synthesize existing evidence to inform the design and conduct of future preference migraine research. This review examined treatment attributes included in preference studies, focusing on how attributes were developed, framed, and presented; how their values were analyzed and reported; and whether these values differed by respondent characteristics.

Methods: A systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42025614690). Embase, MEDLINE, and the Cochrane Library were searched for relevant stated preference studies on migraine treatments (October 2024). Two researchers independently screened studies, and data were extracted using a predefined template. Extracted information included study characteristics, methods for attribute and instrument development, choice task design, attribute framing, and analytical approaches. Narrative synthesis and descriptive statistics were used to summarize findings. Attribute importance was assessed by deriving relative rankings of attributes from marginal utilities or importance scores across studies.

Results: Overall, 18 studies were reviewed from the 186 that were screened. Stated preference methods comprised discrete choice experiment (n = 12), conjoint analysis (n = 1), contingent valuation method (n = 3), thresholding (n = 1), and time trade-off (n = 1). In total, 13 studies reported their attribute development methods, using literature review only (n = 2), expert consultation only (n = 1), and multi-method approaches combining literature reviews with qualitative research and/or expert or payer consultation (n = 10). In addition, 17 studies included at least 1 benefit attribute, resulting in 26 unique attributes grouped into seven overarching concepts. Risk attributes were included in 11 studies, with injection site reactions (n = 5), gastrointestinal effects (n = 4), and cognitive effects (n = 3) as the most common adverse events. Administration-related attributes appeared in ten studies, with mode and/or frequency of administration being the most common (n = 10). Eight studies used visual aids to illustrate attributes. Preference heterogeneity was explored in 14 studies, primarily on the basis of sex (n = 9), monthly migraine days (n = 8), and treatment experience (n = 7).

Conclusions: This review reveals substantial variation in how treatment attributes were selected, framed, and analyzed across studies. Greater methodological consistency in attribute development, framing, and reporting, along with more robust exploration of preference heterogeneity, is needed to enhance the comparability, validity, and application of future preference research in migraine care.