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Migraine Preventative Therapies |
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BY MAURY BREECHER
Contributing Writer |
SCOTTSDALE, ARIZ. (ECCC)—
Preventive migraine treatment drugs can reduce migraine
treatment costs for office visits, emergency department visits,
CT scans, and medication use, however, patients should be warned
of long latency periods and possible side effects, reported Dr.
Mark Green on February 20 at a Headache Research Summit
sponsored by the Diamond Headache Clinic Research and Education
Foundation.
An 18-month comparison study revealed that preventive medicine
reduces migraine treatment costs by reducing the need for office
visits by 51%, emergency department visits by 82%, CT scans by
75%, and medications costs by anywhere from $88 to $138 per
month per patient (Headache. 2003;43:171-178).
However, “an extremely low percentage, less than 5%, of all
migraineurs is on preventive therapy although 53% of the
migraine population meets the disability and frequency criteria
for preventive therapies,” said Dr. Green, director of Headache
Medicine and clinical professor of neurology at Columbia
University, New York.
Migraine preventive treatment should be considered when headache
frequency is more than three per month, when headache-related
disability occurs too often regardless of headache frequency,
and when acute medications are ineffective or likely to be
overused or contraindicated, explained Dr. Green.
Before putting a patient on preventive therapy for migraine, Dr.
Green suggested physicians following certain steps: advise the
patient regarding latency and side effects; start low, go slow,
but strive for a therapeutic dose; treat for an adequate
duration; evaluate patients’ responses by using diary calendars;
and prescribe concomitant acute therapy but avoid interfering or
overuse of these medications.
“It is essential to explain to patients that preventive agents
work slowly,” he continued. “Be specific, say something like,
‘I’m giving you this, you’re going to have side effects and no
benefit whatsoever for awhile. Hopefully, over time you will
have fewer side effects and more benefits.’”
Dr. Green emphasized that physicians have to give that type of
specific instructions—otherwise patients will discontinue
preventive treatment.
He continued that since migraineurs often have co-morbidities
and/or co-existing conditions, when these are present,
clinicians need to be mindful of what they prescribe to avoid
drug interactions. For instance, if the migraineur suffers from
depression, ß-blockers should be avoided; and if the migraineur
has had a stoke, aspirin may be prescribed but not Ergot and
triptan.
Dr. Green said that while a wide variety of drugs have been used
as preventive therapies, including calcium channel blockers,
antiepileptic drugs, antidepressants, and NSAIDs, only five
drugs have been shown with “good strength of evidence” to have
medium to high efficacy for treatment over a range of severity
and infrequent or acceptable side effects. He identified those
drugs as amitriptyline, divalproex sodium, propranolol, timolol,
and topiramate.
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| Copyright 2008 Elsevier Custom Conference Coverage. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the copyright owner. No responsibility is assumed by the Publisher for any injury and/or damage to persons or property as a matter of products liability, through negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Because of rapid advances in the medical sciences, the Publisher recommends that independent verification of diagnoses and drug dosages should be made. Opinions expressed in this publication are those of the original authors and do not necessarily reflect those of the Publisher, the sponsor, or the editors. Elsevier assumes no liability for any material published herein. |
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