Effect of preventive (β blocker) treatment, behavioural migraine management, or their combination on outcomes of optimised acute treatment in frequent migraine: randomised controlled trial
Objective To determine if the addition of preventive drug treatment (β blocker), brief behavioural migraine management, or their combination improves the outcome of optimised acute treatment in the management of frequent migraine.Design Randomised placebo controlled trial over 16 months from July 20...
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| Veröffentlicht in: | BMJ 2010-09, Vol.341 (7776), p.769-769 |
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| creator | Holroyd, Kenneth A Cottrell, Constance K O’Donnell, Francis J Cordingley, Gary E Drew, Jana B Carlson, Bruce W Himawan, Lina |
| description | Objective To determine if the addition of preventive drug treatment (β blocker), brief behavioural migraine management, or their combination improves the outcome of optimised acute treatment in the management of frequent migraine.Design Randomised placebo controlled trial over 16 months from July 2001 to November 2005.Setting Two outpatient sites in Ohio, USA.Participants 232 adults (mean age 38 years; 79% female) with diagnosis of migraine with or without aura according to International Headache Society classification of headache disorders criteria, who recorded at least three migraines with disability per 30 days (mean 5.5 migraines/30 days), during an optimised run-in of acute treatment.Interventions Addition of one of four preventive treatments to optimised acute treatment: β blocker (n=53), matched placebo (n=55), behavioural migraine management plus placebo (n=55), or behavioural migraine management plus β blocker (n=69).Main outcome measure The primary outcome was change in migraines/30 days; secondary outcomes included change in migraine days/30 days and change in migraine specific quality of life scores.Results Mixed model analysis showed statistically significant (P≤0.05) differences in outcomes among the four added treatments for both the primary outcome (migraines/30 days) and the two secondary outcomes (change in migraine days/30 days and change in migraine specific quality of life scores). The addition of combined β blocker and behavioural migraine management (−3.3 migraines/30 days, 95% confidence interval −3.2 to −3.5), but not the addition of β blocker alone (−2.1 migraines/30 days, −1.9 to −2.2) or behavioural migraine management alone (−2.2 migraines migraines/30 days, −2.0 to −2.4), improved outcomes compared with optimised acute treatment alone (−2.1 migraines/30 days, −1.9 to −2.2). For a clinically significant (≥50% reduction) in migraines/30 days, the number needed to treat for optimised acute treatment plus combined β blocker and behavioural migraine management was 3.1 compared with optimised acute treatment alone, 2.6 compared with optimised acute treatment plus β blocker, and 3.1 compared with optimised acute treatment plus behavioural migraine management. Results were consistent for the two secondary outcomes, and at both month 10 (the primary endpoint) and month 16.Conclusion The addition of combined β blocker plus behavioural migraine management, but not the addition of β blocker alone or behavioural migraine management alone, |
| doi_str_mv | 10.1136/bmj.c4871 |
| format | Article |
| fullrecord | <record><control><sourceid>jstor_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_2947621</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><jstor_id>25738383</jstor_id><sourcerecordid>25738383</sourcerecordid><originalsourceid>FETCH-LOGICAL-b556t-aaf6084ee113f8bcdb681faf1d8fe1b154f83a0dfc98c6172790f55147ab82823</originalsourceid><addsrcrecordid>eNqFkt2K1DAYhoso7rDugRegBBR0wa5J2zSJB4KM6w8uK8K6pyHNfJnJbJuMaTrobXnuLXhNptvdWRVEWuhH3ydvvr8su0_wESFl_bzp1ke64ozcymakqnlOeVnezmZYUJFzUvK97KDv1xjjomRc1PRutldgzjEXfJb9ODYGdETeoE2ALbhot4Ce_vyOmtbrCwiHKAZQsUvKM9TASm2tH4JqUWeXQVkHqFNOLWECfEBxBTYg7bvGOhWtd2h8h5j-QD_e4zfRdraHBVJ6iHDjj6xDJsCXYYyv7V-goNzCTwe0dzH4tk1hDFa197I7RrU9HFx997PPb47P5u_yk49v389fneQNpXXMlTI15hVAapjhjV40NSdGGbLgBkhDaGV4qfDCaMF1TVjBBDaUkoqphhe8KPezl5PvZmg6WOiUYGqB3ATbqfBNemXln4qzK7n0W1mIitUFSQZPrgyCT_X1UaaCNLStcuCHXvKiqASjaXT_IxmtC8HLeiQf_UWu02Rc6oMkYpy-YJfU4UTp4Ps-gNllTbAcF0imBZKXC5TYh7-XuSOv1yUBDyZg3UcfbnTKSp6epOeTbvsIX3e6CheyZiWj8vR8Lj_gT-evxWklzxL_eOLHHP6d1y8EQuwS</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1909599768</pqid></control><display><type>article</type><title>Effect of preventive (β blocker) treatment, behavioural migraine management, or their combination on outcomes of optimised acute treatment in frequent migraine: randomised controlled trial</title><source>MEDLINE</source><source>BMJ Journals - NESLi2</source><source>Applied Social Sciences Index & Abstracts (ASSIA)</source><source>Jstor Complete Legacy</source><creator>Holroyd, Kenneth A ; Cottrell, Constance K ; O’Donnell, Francis J ; Cordingley, Gary E ; Drew, Jana B ; Carlson, Bruce W ; Himawan, Lina</creator><creatorcontrib>Holroyd, Kenneth A ; Cottrell, Constance K ; O’Donnell, Francis J ; Cordingley, Gary E ; Drew, Jana B ; Carlson, Bruce W ; Himawan, Lina</creatorcontrib><description>Objective To determine if the addition of preventive drug treatment (β blocker), brief behavioural migraine management, or their combination improves the outcome of optimised acute treatment in the management of frequent migraine.Design Randomised placebo controlled trial over 16 months from July 2001 to November 2005.Setting Two outpatient sites in Ohio, USA.Participants 232 adults (mean age 38 years; 79% female) with diagnosis of migraine with or without aura according to International Headache Society classification of headache disorders criteria, who recorded at least three migraines with disability per 30 days (mean 5.5 migraines/30 days), during an optimised run-in of acute treatment.Interventions Addition of one of four preventive treatments to optimised acute treatment: β blocker (n=53), matched placebo (n=55), behavioural migraine management plus placebo (n=55), or behavioural migraine management plus β blocker (n=69).Main outcome measure The primary outcome was change in migraines/30 days; secondary outcomes included change in migraine days/30 days and change in migraine specific quality of life scores.Results Mixed model analysis showed statistically significant (P≤0.05) differences in outcomes among the four added treatments for both the primary outcome (migraines/30 days) and the two secondary outcomes (change in migraine days/30 days and change in migraine specific quality of life scores). The addition of combined β blocker and behavioural migraine management (−3.3 migraines/30 days, 95% confidence interval −3.2 to −3.5), but not the addition of β blocker alone (−2.1 migraines/30 days, −1.9 to −2.2) or behavioural migraine management alone (−2.2 migraines migraines/30 days, −2.0 to −2.4), improved outcomes compared with optimised acute treatment alone (−2.1 migraines/30 days, −1.9 to −2.2). For a clinically significant (≥50% reduction) in migraines/30 days, the number needed to treat for optimised acute treatment plus combined β blocker and behavioural migraine management was 3.1 compared with optimised acute treatment alone, 2.6 compared with optimised acute treatment plus β blocker, and 3.1 compared with optimised acute treatment plus behavioural migraine management. Results were consistent for the two secondary outcomes, and at both month 10 (the primary endpoint) and month 16.Conclusion The addition of combined β blocker plus behavioural migraine management, but not the addition of β blocker alone or behavioural migraine management alone, improved outcomes of optimised acute treatment. Combined β blocker treatment and behavioural migraine management may improve outcomes in the treatment of frequent migraine.Trial registration Clinical trials NCT00910689.</description><identifier>ISSN: 0959-8138</identifier><identifier>ISSN: 0959-535X</identifier><identifier>EISSN: 1468-5833</identifier><identifier>EISSN: 1756-1833</identifier><identifier>DOI: 10.1136/bmj.c4871</identifier><identifier>PMID: 20880898</identifier><identifier>CODEN: BMJOAE</identifier><language>eng</language><publisher>England: British Medical Journal Publishing Group</publisher><subject>Adolescent ; Adrenergic beta-Antagonists - therapeutic use ; Adult ; Aged ; Antidepressants ; Attention deficit disorder ; Behavior Therapy - methods ; Behaviour therapy ; Beta blockers ; Classification ; Cleveland Clinic CME ; Clinical medicine ; Clinical trials ; Clinical trials (epidemiology) ; Combined Modality Therapy - methods ; Drug abuse ; Evidence-based medicine ; Experimentation ; Female ; Headache ; Headache (including migraine) ; Headaches ; Humans ; Male ; Medication Adherence ; Middle Aged ; Migraine ; Migraine Disorders - prevention & control ; Pain (neurology) ; Pharmaceutical preparations ; Placebos ; Primary care ; Quality of Life ; Secondary Prevention ; Sociology ; Statistical analysis ; Substance abuse treatment ; Treatment ; Treatment Outcome ; Young Adult</subject><ispartof>BMJ, 2010-09, Vol.341 (7776), p.769-769</ispartof><rights>Holroyd et al 2010</rights><rights>2010 BMJ Publishing Group Ltd</rights><rights>Copyright: 2010 © Holroyd et al 2010</rights><rights>Holroyd et al 2010 2010 Holroyd et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b556t-aaf6084ee113f8bcdb681faf1d8fe1b154f83a0dfc98c6172790f55147ab82823</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://bmj.com/content/341/bmj.c4871.full.pdf$$EPDF$$P50$$Gbmj$$Hfree_for_read</linktopdf><linktohtml>$$Uhttp://bmj.com/content/341/bmj.c4871.full$$EHTML$$P50$$Gbmj$$Hfree_for_read</linktohtml><link.rule.ids>114,115,230,314,780,784,803,885,3196,23571,27924,27925,31000,58017,58250,77600,77631</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20880898$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Holroyd, Kenneth A</creatorcontrib><creatorcontrib>Cottrell, Constance K</creatorcontrib><creatorcontrib>O’Donnell, Francis J</creatorcontrib><creatorcontrib>Cordingley, Gary E</creatorcontrib><creatorcontrib>Drew, Jana B</creatorcontrib><creatorcontrib>Carlson, Bruce W</creatorcontrib><creatorcontrib>Himawan, Lina</creatorcontrib><title>Effect of preventive (β blocker) treatment, behavioural migraine management, or their combination on outcomes of optimised acute treatment in frequent migraine: randomised controlled trial</title><title>BMJ</title><addtitle>BMJ</addtitle><description>Objective To determine if the addition of preventive drug treatment (β blocker), brief behavioural migraine management, or their combination improves the outcome of optimised acute treatment in the management of frequent migraine.Design Randomised placebo controlled trial over 16 months from July 2001 to November 2005.Setting Two outpatient sites in Ohio, USA.Participants 232 adults (mean age 38 years; 79% female) with diagnosis of migraine with or without aura according to International Headache Society classification of headache disorders criteria, who recorded at least three migraines with disability per 30 days (mean 5.5 migraines/30 days), during an optimised run-in of acute treatment.Interventions Addition of one of four preventive treatments to optimised acute treatment: β blocker (n=53), matched placebo (n=55), behavioural migraine management plus placebo (n=55), or behavioural migraine management plus β blocker (n=69).Main outcome measure The primary outcome was change in migraines/30 days; secondary outcomes included change in migraine days/30 days and change in migraine specific quality of life scores.Results Mixed model analysis showed statistically significant (P≤0.05) differences in outcomes among the four added treatments for both the primary outcome (migraines/30 days) and the two secondary outcomes (change in migraine days/30 days and change in migraine specific quality of life scores). The addition of combined β blocker and behavioural migraine management (−3.3 migraines/30 days, 95% confidence interval −3.2 to −3.5), but not the addition of β blocker alone (−2.1 migraines/30 days, −1.9 to −2.2) or behavioural migraine management alone (−2.2 migraines migraines/30 days, −2.0 to −2.4), improved outcomes compared with optimised acute treatment alone (−2.1 migraines/30 days, −1.9 to −2.2). For a clinically significant (≥50% reduction) in migraines/30 days, the number needed to treat for optimised acute treatment plus combined β blocker and behavioural migraine management was 3.1 compared with optimised acute treatment alone, 2.6 compared with optimised acute treatment plus β blocker, and 3.1 compared with optimised acute treatment plus behavioural migraine management. Results were consistent for the two secondary outcomes, and at both month 10 (the primary endpoint) and month 16.Conclusion The addition of combined β blocker plus behavioural migraine management, but not the addition of β blocker alone or behavioural migraine management alone, improved outcomes of optimised acute treatment. Combined β blocker treatment and behavioural migraine management may improve outcomes in the treatment of frequent migraine.Trial registration Clinical trials NCT00910689.</description><subject>Adolescent</subject><subject>Adrenergic beta-Antagonists - therapeutic use</subject><subject>Adult</subject><subject>Aged</subject><subject>Antidepressants</subject><subject>Attention deficit disorder</subject><subject>Behavior Therapy - methods</subject><subject>Behaviour therapy</subject><subject>Beta blockers</subject><subject>Classification</subject><subject>Cleveland Clinic CME</subject><subject>Clinical medicine</subject><subject>Clinical trials</subject><subject>Clinical trials (epidemiology)</subject><subject>Combined Modality Therapy - methods</subject><subject>Drug abuse</subject><subject>Evidence-based medicine</subject><subject>Experimentation</subject><subject>Female</subject><subject>Headache</subject><subject>Headache (including migraine)</subject><subject>Headaches</subject><subject>Humans</subject><subject>Male</subject><subject>Medication Adherence</subject><subject>Middle Aged</subject><subject>Migraine</subject><subject>Migraine Disorders - prevention & control</subject><subject>Pain (neurology)</subject><subject>Pharmaceutical preparations</subject><subject>Placebos</subject><subject>Primary care</subject><subject>Quality of Life</subject><subject>Secondary Prevention</subject><subject>Sociology</subject><subject>Statistical analysis</subject><subject>Substance abuse treatment</subject><subject>Treatment</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0959-8138</issn><issn>0959-535X</issn><issn>1468-5833</issn><issn>1756-1833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><sourceid>7QJ</sourceid><recordid>eNqFkt2K1DAYhoso7rDugRegBBR0wa5J2zSJB4KM6w8uK8K6pyHNfJnJbJuMaTrobXnuLXhNptvdWRVEWuhH3ydvvr8su0_wESFl_bzp1ke64ozcymakqnlOeVnezmZYUJFzUvK97KDv1xjjomRc1PRutldgzjEXfJb9ODYGdETeoE2ALbhot4Ce_vyOmtbrCwiHKAZQsUvKM9TASm2tH4JqUWeXQVkHqFNOLWECfEBxBTYg7bvGOhWtd2h8h5j-QD_e4zfRdraHBVJ6iHDjj6xDJsCXYYyv7V-goNzCTwe0dzH4tk1hDFa197I7RrU9HFx997PPb47P5u_yk49v389fneQNpXXMlTI15hVAapjhjV40NSdGGbLgBkhDaGV4qfDCaMF1TVjBBDaUkoqphhe8KPezl5PvZmg6WOiUYGqB3ATbqfBNemXln4qzK7n0W1mIitUFSQZPrgyCT_X1UaaCNLStcuCHXvKiqASjaXT_IxmtC8HLeiQf_UWu02Rc6oMkYpy-YJfU4UTp4Ps-gNllTbAcF0imBZKXC5TYh7-XuSOv1yUBDyZg3UcfbnTKSp6epOeTbvsIX3e6CheyZiWj8vR8Lj_gT-evxWklzxL_eOLHHP6d1y8EQuwS</recordid><startdate>20100929</startdate><enddate>20100929</enddate><creator>Holroyd, Kenneth A</creator><creator>Cottrell, Constance K</creator><creator>O’Donnell, Francis J</creator><creator>Cordingley, Gary E</creator><creator>Drew, Jana B</creator><creator>Carlson, Bruce W</creator><creator>Himawan, Lina</creator><general>British Medical Journal Publishing Group</general><general>BMJ Publishing Group</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group Ltd</general><scope>9YT</scope><scope>ACMMV</scope><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M2O</scope><scope>M2P</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>7QJ</scope><scope>5PM</scope></search><sort><creationdate>20100929</creationdate><title>Effect of preventive (β blocker) treatment, behavioural migraine management, or their combination on outcomes of optimised acute treatment in frequent migraine: randomised controlled trial</title><author>Holroyd, Kenneth A ; Cottrell, Constance K ; O’Donnell, Francis J ; Cordingley, Gary E ; Drew, Jana B ; Carlson, Bruce W ; Himawan, Lina</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b556t-aaf6084ee113f8bcdb681faf1d8fe1b154f83a0dfc98c6172790f55147ab82823</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adolescent</topic><topic>Adrenergic beta-Antagonists - therapeutic use</topic><topic>Adult</topic><topic>Aged</topic><topic>Antidepressants</topic><topic>Attention deficit disorder</topic><topic>Behavior Therapy - methods</topic><topic>Behaviour therapy</topic><topic>Beta blockers</topic><topic>Classification</topic><topic>Cleveland Clinic CME</topic><topic>Clinical medicine</topic><topic>Clinical trials</topic><topic>Clinical trials (epidemiology)</topic><topic>Combined Modality Therapy - methods</topic><topic>Drug abuse</topic><topic>Evidence-based medicine</topic><topic>Experimentation</topic><topic>Female</topic><topic>Headache</topic><topic>Headache (including migraine)</topic><topic>Headaches</topic><topic>Humans</topic><topic>Male</topic><topic>Medication Adherence</topic><topic>Middle Aged</topic><topic>Migraine</topic><topic>Migraine Disorders - prevention & control</topic><topic>Pain (neurology)</topic><topic>Pharmaceutical preparations</topic><topic>Placebos</topic><topic>Primary care</topic><topic>Quality of Life</topic><topic>Secondary Prevention</topic><topic>Sociology</topic><topic>Statistical analysis</topic><topic>Substance abuse treatment</topic><topic>Treatment</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Holroyd, Kenneth A</creatorcontrib><creatorcontrib>Cottrell, Constance K</creatorcontrib><creatorcontrib>O’Donnell, Francis J</creatorcontrib><creatorcontrib>Cordingley, Gary E</creatorcontrib><creatorcontrib>Drew, Jana B</creatorcontrib><creatorcontrib>Carlson, Bruce W</creatorcontrib><creatorcontrib>Himawan, Lina</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Holroyd, Kenneth A</au><au>Cottrell, Constance K</au><au>O’Donnell, Francis J</au><au>Cordingley, Gary E</au><au>Drew, Jana B</au><au>Carlson, Bruce W</au><au>Himawan, Lina</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of preventive (β blocker) treatment, behavioural migraine management, or their combination on outcomes of optimised acute treatment in frequent migraine: randomised controlled trial</atitle><jtitle>BMJ</jtitle><addtitle>BMJ</addtitle><date>2010-09-29</date><risdate>2010</risdate><volume>341</volume><issue>7776</issue><spage>769</spage><epage>769</epage><pages>769-769</pages><issn>0959-8138</issn><issn>0959-535X</issn><eissn>1468-5833</eissn><eissn>1756-1833</eissn><coden>BMJOAE</coden><abstract>Objective To determine if the addition of preventive drug treatment (β blocker), brief behavioural migraine management, or their combination improves the outcome of optimised acute treatment in the management of frequent migraine.Design Randomised placebo controlled trial over 16 months from July 2001 to November 2005.Setting Two outpatient sites in Ohio, USA.Participants 232 adults (mean age 38 years; 79% female) with diagnosis of migraine with or without aura according to International Headache Society classification of headache disorders criteria, who recorded at least three migraines with disability per 30 days (mean 5.5 migraines/30 days), during an optimised run-in of acute treatment.Interventions Addition of one of four preventive treatments to optimised acute treatment: β blocker (n=53), matched placebo (n=55), behavioural migraine management plus placebo (n=55), or behavioural migraine management plus β blocker (n=69).Main outcome measure The primary outcome was change in migraines/30 days; secondary outcomes included change in migraine days/30 days and change in migraine specific quality of life scores.Results Mixed model analysis showed statistically significant (P≤0.05) differences in outcomes among the four added treatments for both the primary outcome (migraines/30 days) and the two secondary outcomes (change in migraine days/30 days and change in migraine specific quality of life scores). The addition of combined β blocker and behavioural migraine management (−3.3 migraines/30 days, 95% confidence interval −3.2 to −3.5), but not the addition of β blocker alone (−2.1 migraines/30 days, −1.9 to −2.2) or behavioural migraine management alone (−2.2 migraines migraines/30 days, −2.0 to −2.4), improved outcomes compared with optimised acute treatment alone (−2.1 migraines/30 days, −1.9 to −2.2). For a clinically significant (≥50% reduction) in migraines/30 days, the number needed to treat for optimised acute treatment plus combined β blocker and behavioural migraine management was 3.1 compared with optimised acute treatment alone, 2.6 compared with optimised acute treatment plus β blocker, and 3.1 compared with optimised acute treatment plus behavioural migraine management. Results were consistent for the two secondary outcomes, and at both month 10 (the primary endpoint) and month 16.Conclusion The addition of combined β blocker plus behavioural migraine management, but not the addition of β blocker alone or behavioural migraine management alone, improved outcomes of optimised acute treatment. Combined β blocker treatment and behavioural migraine management may improve outcomes in the treatment of frequent migraine.Trial registration Clinical trials NCT00910689.</abstract><cop>England</cop><pub>British Medical Journal Publishing Group</pub><pmid>20880898</pmid><doi>10.1136/bmj.c4871</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0959-8138 |
| ispartof | BMJ, 2010-09, Vol.341 (7776), p.769-769 |
| issn | 0959-8138 0959-535X 1468-5833 1756-1833 |
| language | eng |
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| source | MEDLINE; BMJ Journals - NESLi2; Applied Social Sciences Index & Abstracts (ASSIA); Jstor Complete Legacy |
| subjects | Adolescent Adrenergic beta-Antagonists - therapeutic use Adult Aged Antidepressants Attention deficit disorder Behavior Therapy - methods Behaviour therapy Beta blockers Classification Cleveland Clinic CME Clinical medicine Clinical trials Clinical trials (epidemiology) Combined Modality Therapy - methods Drug abuse Evidence-based medicine Experimentation Female Headache Headache (including migraine) Headaches Humans Male Medication Adherence Middle Aged Migraine Migraine Disorders - prevention & control Pain (neurology) Pharmaceutical preparations Placebos Primary care Quality of Life Secondary Prevention Sociology Statistical analysis Substance abuse treatment Treatment Treatment Outcome Young Adult |
| title | Effect of preventive (β blocker) treatment, behavioural migraine management, or their combination on outcomes of optimised acute treatment in frequent migraine: randomised controlled trial |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-25T03%3A51%3A37IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-jstor_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Effect%20of%20preventive%20(%CE%B2%20blocker)%20treatment,%20behavioural%20migraine%20management,%20or%20their%20combination%20on%20outcomes%20of%20optimised%20acute%20treatment%20in%20frequent%20migraine:%20randomised%20controlled%20trial&rft.jtitle=BMJ&rft.au=Holroyd,%20Kenneth%20A&rft.date=2010-09-29&rft.volume=341&rft.issue=7776&rft.spage=769&rft.epage=769&rft.pages=769-769&rft.issn=0959-8138&rft.eissn=1468-5833&rft.coden=BMJOAE&rft_id=info:doi/10.1136/bmj.c4871&rft_dat=%3Cjstor_pubme%3E25738383%3C/jstor_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1909599768&rft_id=info:pmid/20880898&rft_jstor_id=25738383&rfr_iscdi=true |