To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: DG DISPATCH - AASH: Match Migraine Treatment To Patients' Headache Profile, Researcher Says URL: http://www.pslgroup.com/dg/13EE86.htm Doctor's Guide October 27, 1999
By Alice Goodman Special to DG News
SCOTTSDALE, AZ -- October 25, 1999 -- The results of a new study demonstrate that stratified care (SC) is a superior approach to management of migraine headache compared to stepped care across attacks (SCAA) or stepped care within attacks (SCWA).
These results were presented at the Fall 1999 Headache Symposium of the American Association for the Study of Headache (October 22-24, 1999), in Scottsdale, AZ., by Dr. Richard B. Lipton, Professor of Neurology, Epidemiology and Social Medicine, Albert Einstein College of Medicine, in Bronx, New York, and CEO of Innovative Medical Research, in Stamford, CT.
Stratified care allows the clinician to match the treatment to the severity and level of disability for each patient, as assessed by an instrument called the MIDAS (Migraine Disability Assessment) questionnaire. Using the stratified care approach, treatment is initiated with the optimal therapy up front, sparing the patient from prolonged pain and disability.
The stepped care approach begins with simple analgesics for all patients, and if those are not effective, the patient is "stepped up" to the next level of treatment, reserving the more powerful triptans as third-line options. This approach results in longer periods of intense pain for patients with more intense pain.
The DISC (Disability in Strategies for Care) study enrolled 1062 patients with 4945 migraine attacks. Patients were treated for six attacks and were randomized to receive SC, SCAA or SCWA. Baseline characteristics of all three groups were similar.
Disability was assessed by the five-question MIDAS questionnaire. In the SC group, patients with a MIDAS score that indicated mild disability (Grade II) were treated with aspirin 800-1000 mg and metoclopramide 10 mg p.o., while those with more severe migraine-related disability (MIDAS Grades III/IV) were treated with zolmitriptan 2.5 mg. In the SCAA group, attacks 1-3 were treated with aspirin plus metoclopramide and this treatment was continued for attacks 4-6 if it was successful for the first three attacks. If aspirin plus metoclopramide treatment was not successful in the first three attacks, patients were switched to zolmitriptan 2.5 mg for attacks 4-6.
In the SCWA group, patients received aspirin plus metoclopramide for all six attacks, and were switched to zolmitriptan at two hours if the headache was of moderate to severe intensity.
For all attacks, escape medication was allowed if the pain was still severe at four hours post-treatment.
The results show that stratified care was significantly superior to stepped care across attacks over six migraine attacks. Following stratified care, there was significantly less disability as measured by the MIDAS questionnaire and significantly greater headache relief and pain-free response at two hours after treatment. The advantage of stratified care was mainly evident in the differences in outcome over the first three attacks, when the stepped care group was treated with suboptimal medications. For the second three attacks, these patients' medications were stepped up to zolmitriptan, so the differences between groups narrowed for a four-hour time point measurement of response and pain-free status.
The same pattern was seen when stratified care was compared with stepped care within attacks, except that the differences between stratified and stepped care were significant for each attack, with significantly less disability and greater headache relief and pain-free status at two hours after treatment in the stratified care group. Once patients in the stepped care group were given zolmitriptan (if their relief was inadequate at two hours), then the differences between groups narrowed. --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. P\S\L shall not be liable for any errors, omissions or delays in this content or any other content on its sites, newsletters or other publications, nor for any decisions or actions taken in reliance on such content. --------------------------------------------------------------------------------------------- This news story was printed from *Doctor's Guide to the Internet* located at http://www.docguide.com --------------------------------------------------------------------------------------- Return to News Story Page This site is maintained by webmaster@pslgroup.com Please contact us with any comments, problems or bugs. All contents Copyright (c) 1998 P\S\L Consulting Group Inc. All rights reserved.