One of the issues about Migraine treatment that has arisen here at times is whether switching from one triptan to another or to an opioid, barbiturate, or NSAID for treatment when we get a Migraine would produce better results.
At the annual scientific meeting of the American Headache Society last month, one of the presentations addressed that issue. The presenting team had studied data from the American Migraine Prevalence and Prevention (AAMP) Study to address this question. Participants had Migraine treated with a triptan one year and one of the following the next year:
- the same triptan,
- changed to a different triptan,
- changed to an opioid or barbiturate, or
- changed to an NSAID.
The outcome the team looked for was any change in Migraine-related disability, measured by the MIDAS questionnaire.
- 146 participants met the criteria to be included.
- Among the participants who stayed with the same triptan, the MIDAS change was -7.4 points, a reduction in disability, an improvement.
- Among the participants who changed to a different triptan, the MIDAS change was -3.5 points, also a reduction, an improvement.
- Among the participants who changed to an opioid or barbiturate, the MIDAS change was 3.4 points, an increase in disability.
- Among the participants who changed to an NSAID, the MIDAS change was 10.3, also an increase in disability.
The presenters concluded:
"These findings suggest that on average, switching from a triptan to another triptan, an opioid or a barbiturate, or NSAID was not associated with significant improvement in headache-related disability relative to those who kept treatment constant. These findings suggest that improvements in Migraine management are needed, especially for those with elevated headache frequency."
Summary and comments:
This presentation provides valuable information for those of us who have wondered about changing treatments and those of us who have perhaps tried it, but not really been able to tell how much difference the change made for us. Granted, we all respond differently to treatment, but this kind of information can be quite helpful in giving us a foundation for discussion with our doctors. This information adds to the growing body of evidence that overall disease management is crucial.
Serrano, D.; Buse, D.C.; Papapetropoulos, S.; Cunanan, C.M.; Kori, S.H.; Manack, A.N.; Reed, M.L.; Lipton, R.B. "Does Switching Treatment Improve Headache-Related Disability in Patients on Triptans? Results of the American Migraine Prevalence & Prevention (AMPP) Study. Oral Presentation. 54th Annual Scientific Meeting of the American Headache Society. Los Angeles. June, 2012.
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