The elegant research by Professor Lipton and colleagues clearly documents a fact that all headache doctors know, but always like more evidence for—that acute treatment of migraine in the population is less than ideal. It goes on to carefully show that treatment results for chronic migraine are worse than those for episodic migraine.
Using respondents from the American Migraine Prevalence and Prevention study who completed the M-TOQ-5, Dr. Lipton and colleagues evaluated how well patients did after taking acute care medication, in terms of functioning, rapidity of relief, consistency of relief, risk of recurrence, and medication tolerability. As might be expected, there is a lot of room for improvement. These patients are taken from the population at large, not from a headache specialist’s office, so they might not be getting the best expert care. But when only 52% of patients with episodic migraine say they can quickly return to normal activities at least half the time, and only 45% of these patients are pain-free in two hours at least half the time, we can see that we need to strive for more effective treatments. In every parameter studied by Dr. Lipton, patients with chronic migraine lagged behind those with episodic migraine.
What can we do? This research points out that we need better medications, given early in the migraine attack via different routes of administration, probably combined with behavioral medicine techniques such as biofeedback therapy, relaxation techniques, and cognitive restructuring. This will help us to bridge the gap between where we currently are with optimizing migraine therapy and where we and our patients would like to be.
—Alan M. Rapoport, MD
Clinical Professor of Neurology
David Geffen School of Medicine
University of California, Los Angeles
To read the accompanying article, please click here.