Weighing Approaches on Preventive Use, Medication Overuse in Chronic Migraine: Vincent Martin, MD

WATCH TIME: 4 minutes

"In the past, what we’ve done is said, ‘Well, let’s put them on a preventive,’ and then we have to withdraw the medication. I can tell you that can be somewhat contentious because the patient thinks they’re taking the medication to treat their headaches and if they don’t take the medication, their headaches are going to be out of control, get worse, or they’re going to be more disabled."

Medication overuse is common among patients with chronic migraine and much debate has taken place over how these patients should be treated. Identifying an effective preventive should be step one, Vincent Martin, MD, says, but when it appears they are overusing the medication, they should not feel as pressured to switch. Martin, president of the National Headache Foundation, was a part of the recently conducted Medication Overuse Treatment Strategy trial, which found migraine prevention medication without switching or limiting symptomatic medication to be not inferior to migraine preventive medication with switching to a symptomatic medication a maximum limit of 2 treatment days per week.

The study included 723 randomized adults from 34 clinics in the US, including headache specialty, general neurology, and primary care clinics. The primary outcome, moderate to severe headache day frequency during weeks 9 to 12 was not inferior between the 2 groups (switching, 9.3 [SD, 7.2] vs no switching, 9.1 [SD, 6.8]; P = 0.75; 95% CI, –1.0 to 1.3).

In an interview with NeurologyLive^®, Martin discussed how common medication overuse is in this chronic population and the ways headache specialists have typically tried to combat it. He also provided insight on whether these results change the way clinicians should approach medication strategies for chronic migraine, as well as what questions still remain.

REFERENCE
1. Schwedt TJ, Hentz JG, Sahai-Srivastava S, et al. Patient-centered treatment of chronic migraine with medication overuse: a prospective, randomized, pragmatic clinical trial. Neurology. 2022;98(14). doi:10.1212/WNL.0000000000200117