Combination Therapy Helps Curb Frequent Migraines

This study was undertaken to test the effect of different approaches to management of frequent migraines. Patients, in addition to being given a standard medication for optimized acute treatment for migraines, were divided into four groups with one group receiving a preventive drug; another group receiving a placebo; the third receiving behavioral therapy for migraine plus a preventative drug; and the fourth group receiving behavioral therapy and a placebo. The combination of behavioral therapy with a preventative drug was shown to be more effective than the other treatments.

Migraines are common affecting approximately 14 percent of women and 6 percent of men worldwide; around one-third (31 percent) of these people report frequent migraines defined as three or more attacks a month. Repeated attacks of migraines necessitate bed rest, days off from work and may also lead to subsequent damage to nerves and the brain. Medicinal therapy at present can show efficacy only in about half of these patients. Behavioral therapy, including management of stress and counseling has shown 40 to 50 percent effectiveness. This study attempted to see whether a combination of the two methods could yield better results in effectively treating frequent migraines.

•    A total of 232 patients between ages 18 and 65 suffering at least three attacks per month were included in the study, which took sixteen months to carry out. The first four months were the “treatment phase” while the next 12 months were the “evaluation phase.”
•    The participants, were divided into four groups: (1) 53 patients receiving a preventive drug (beta blocker); (2) 55 patients receiving a placebo; (3) another 55 patients receiving behavioral therapy along with a placebo; and (4) 69 patients receiving behavioral therapy along with a beta blocker tablet. Apart from these options, all patients were already on standard treatment for migraines.
•    Behavioral therapy involved relaxation therapy, stress relief and various counseling techniques to “prevent, abort and cope with migraines.”
•    Periodic clinic visits and telephone contacts were maintained with the patients throughout the study period. Patients maintained records of frequency of migraine attacks, their severity and their effect on quality of life.

•    Improvement in migraine frequency was noted in 77 percent of the participants who were given beta blockers and behavioral therapy, as well as standard therapy for migraine attacks.
•    Beta blockers with standard therapy, or behavioral therapy with standard therapy, did not show any improvement over standard therapy alone.
•    Scores and questionnaires showed that patient perception of quality of life improved with the combined therapy at 10 and 16 months of assessment.
•    A total of 13 percent patients withdrew from beta blocker therapy during the 16-month trial due to side effects caused by the drug. Fatigue was the most commonly reported side effect.

Next steps/Shortcomings
The researchers admit that frequent attacks of migraines may have some psychological effects on the patients and could have erroneously led to better treatment outcomes with behavioral therapy combined with medications. Secondly, the findings of this research project do not apply to people suffering from other kinds of pain disorders because they were not included in the study. Further trials comparing other preventive medications like antidepressants, newer forms of beta blockers and behavioral approaches are also suggested by researchers to understand the role of these migraine therapies.

Only the combination of beta blocker treatment and brief behavioral migraine management improved outcomes obtained with optimized acute treatment in this trial. Since these are preventive approaches to the severely debilitating ailment, they hold a lot of promise in improving the results of migraine management. This is the first study that combines both approaches — advanced drug treatment and behavioral therapy — with the standard optimized acute treatment and sets a precedent for further studies and development of therapeutic approaches to reduce or stop the progress of migraines into becoming more serious brain damage.

For More Information:
Effect of Preventive Treatment, Behavioral Management or Their Combination on Frequent Migraines
Publication Journal: British Medical Journal, June 2010
By Kenneth A. Holroyd; Constance K. Cottrell; Ohio University, Athens, Ohio and Headache Treatment and Research, Westerville, Ohio

*FYI Living Lab Reports Are Summaries of the Original Research.
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