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| December 1 | |
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Removing the Headache in Treating Migraines |
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The typical migraine sufferer tries an average of nearly 6 medications before finding one that works for them. A report in the Journal of the American Medical Association shows that there may be a better way to approach this problem. This article addresses the difference between two different ways to treat pain—there’s what’s called the step care approach, and the stratified care approach. In step care, the doctor recommends the simplest medications and then steps up the ladder to stronger medications until one works. But researchers from the Albert Einstein College of Medicine in the Bronx, N.Y., found that the quickest way to relief was to choose the first medication based on how bad the migraine was and how it affected the patient’s life. This is stratified care. They used three medicines—aspirin, metoclopramide and zolmitriptan, alone or in combination to treat more than 800 migraine patients, some using step care, and others using stratified care. The results showed that stratified care produced dramatically better outcomes than the step care approach. For example, if we use a measure of headache response at two hours, patients were perhaps 50% more likely to show improvement using the method where treatment was selected based on severity of illness as opposed to the step care approach. The results of this study support recent national guidelines developed by headache experts that urge doctors to select treatment based on the severity of the symptoms. |
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Why is this an issue—won’t most doctors use this information? A doctor’s credo is to "do no harm," and there may be some concern about using stronger medicine first, because of the concern that they may have more side effects—but hopefully studies like this one will help to change the way we think about pain management. Other ways to change doctors' mindset—patients should talk with their doctors. | |
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Resources and References:
Stratified Care vs Step Care Strategies for Migraine |
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