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Acute antimigraine drugs cut risk of chronicity.


LONDON--Using any acute antimigraine medication--be it single or combination analgesics, or triptans--exerted a protective effect against developing chronic migraine in a large, prospective study of episodic migraineurs.

"This effect seems to be stronger for single analgesics and triptans than for combination analgesics," Dr. Zaza Katsarava said in presenting findings from the German Headache Consortium Study.

He reported on 1,601 study participants with baseline episodic migraine--meaning migraine headaches on an average of not more than 14 days per month--who were prospectively followed for 2 years. None were on any form of prophylactic pain medication.

The goal was to learn whether use of acute antimigraine medication to abort attacks predisposes patients over time to what has been termed "migraine chroni-fication," or the conversion of episodic migraine into even more disabling and burdensome chronic headache, which in this study was defined as any type of headache occurring 15 or more days per month. There has been controversy regarding whether combination analgesics in particular might have such an unwanted effect.

"The purpose of our study is to learn whether general use of one of these classes of substances is associated with higher risk, in which case we would no longer advise their use in our patients," explained Dr. Katsarava, a neurologist at the University of Essen (Germany).

The answer proved reassuring. During 2 years of follow-up, 6.2% of patients with episodic migraine at baseline developed chronic headache. Compared with the 151 subjects who didn't use any acute antimigraine medication, those who used single analgesics for that purpose had an adjusted 61% lower risk of progressing to chronic headache. Patients who used triptans had a 66% reduction in risk, and those who utilized combination analgesics had a 40% risk reduction, compared with no intake of acute antimigraine medication. This analysis was adjusted for age, sex, body mass index, education level, and baseline migraine frequency.

The protective effect was significantly greater with single analgesic medications as compared to combination analgesics, as reflected in a 35% lower relative risk of conversion to chronic headache.

But do patients who take single analgesics for acute antimigraine therapy have less severe migraine attacks? And does that account for their lower risk of chronic headache? "It's the right thing to ask. It's the argument that the pharmaceutical

companies manufacturing combination analgesics make. But headache intensity has never been shown to be a risk factor for developing chronic headache ... We know that what counts is the frequency of attacks, and we controlled for that," Dr. Katsarava said.

'This effect seems to be stronger for single analgesics and triptans than for combination analgesics.'


Major Finding: Patients who used single analgesics, combination analgesics, or triptans as acute antimigraine medications had, respectively, 61%, 40%, and 66% lower risks of converting to chronic headache over a 2-year period than did nonusers of acute antimigraine agents.

Data Source: The German Headache Consortium Study is a prospective population-based study including 18,000 adults.

Disclosures: The study was funded by the German Federal Ministry of Education and Research. Dr. Katsarava is a consultant to Allergan and a speaker for several companies.
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Title Annotation:NEUROLOGY
Author:Jancin, Bruce
Publication:Internal Medicine News
Article Type:Clinical report
Date:Nov 15, 2012
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