There’s great news on the migraine research front. The Patient-Centered Outcomes Research Institute (PCORI) just announced their grant funding in the category of Pragmatic Clinical Studies and Large Simple Trials to Evaluate Patient-Centered Outcomes. Among the projects approved for funding was this one - Determining the Optimal Treatment Strategy for Patients Who Have Chronic Migraine with Medication Overuse.
Medication overuse has been a catch-22 and a thorn in the sides of migraine patients, perhaps especially those with chronic migraine. First, there’s the question of what we can do once we’ve used our acute medications as many times in a week as we can without risking medication overuse headache. Another issue is that it seems that many preventive treatments can’t kick in and work when we’re in a state of medication overuse. To complicate matters even more, the best strategy for those of us with chronic migraine with medication overuse is uncertain.
There are two main strategies in use for treating patients who have chronic migraine with medication overuse, and there is some evidence of effectiveness for both of them, but not clear-cut evidence of which works better. The two strategies are:
- discontinuation of the overused medication, along with daily migraine prevention medication; and
- migraine preventive therapy without discontinuation of the overused medication (until such time as the preventive becomes effective).
Doctors are now using both of these strategies, but two things remain unknown:
- if one of these methods is superior to the other, or
- if they provide similar outcomes.
Certainly, if they provide similar outcomes, the second strategy would be preferable since the first strategy can cause a period of increased migraine attacks, increased migraine severity, increased functional impairment, and an inability of patients to remain compliant with and adherent to the treatment plan.
Now, with PCORI support, a study can be conducted to evaluate and compare the two strategies, determining which one is more effective and best for patients. Dr. Todd Schwedt and Dr. David Dodick, both migraine and headache specialists at the Mayo Clinic in Scottsdale, Arizona, are the principal investigators for this study. I’m honored and excited to be able to report that I’m a co-investigator for the study. This is a five-year project that has been approved by PCORI for $7,739,297 in funding.
I’ll be telling you more as we ramp up this project. For now, thank you, PCORI, and congratulations, Dr. Schwedt and Dr. Dodick.
_Reviewed by David Watson, MD. _
Author of “Living Well with Migraine Disease and Headaches”