Combined Treatment Eases Migraine Activity: Three-Part Therapy Produced at Least 50% Reduction in Episodes, Migraine Days in 80% of Patients

Article excerpt

WASHINGTON -- The combination of optimized acute medication, preventive medication, and behavioral therapy significantly reduced migraine activity, according to study results presented at the annual meeting of the American Pain Society.

In a study of 232 patients with frequent, disabling migraine, Kenneth A. Holroyd, Ph.D., distinguished professor of psychology at Ohio University in Athens, and his colleagues assessed the effectiveness of optimal acute therapy (OAT); OAT plus preventive medications; OAT plus behavioral migraine management; or OAT plus a combination of preventive medications and behavioral migraine management.

All treatments reduced the number of migraine episodes. However, neither preventive medication nor behavioral management in combination with acute medication made a significant difference. But the combination of all three--preventive medication, behavioral therapy, and acute medication--caused a significant improvement in outcome, Dr. Holroyd said.

Potential participants met the International Headache Society criteria for migraine. They had to have a minimum of three migraines per month with significant migraine-related disability. Individuals with medication overuse complications were excluded. Patients who met these criteria completed a 5-week run-in period of acute therapy (triptans, NSAIDs, antiemetics, and rescue medications as needed).

Most of the participants were women (79%). The average age was 38 years and most patients were white (84%). Patients had an average of 5.5 migraine episodes per 30 days and 8.5 migraine days per month.

The patients were randomized to one of four treatment groups. Triptan dose and route of administration were adjusted to achieve optimal acute therapy. Use of antiemetic and rescue medications was adjusted for optimal effect. The primary preventive medication was propranolol-LA (up to 240 mg/day). However, if the drug was ineffective or intolerable, nadolol (up to 120 mg/day) was used. …