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The influence of multimodal behavioral treatment on the consumption of acute migraine drugs: a randomized, controlled study
University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Medical science.
Uppsala Universitet.
2012 (English)In: Cephalalgia, ISSN 0333-1024, E-ISSN 1468-2982, Vol. 32, no 4, p. 297-307Article in journal (Refereed) Published
Abstract [en]

Objectives: To characterize overall drug use in migraine in conjunction with multimodal behavioral treatment (MBT). Methods: Seventy-six adults reporting at least two monthly migraine attacks underwent a randomized, controlled, 24-week MBT intervention. Migraine drugs and symptoms were registered in an Internet-based diary. Results: During 4256 days of baseline registration, 859 drug doses were taken during 655 of the 856 days with migraine headache. Triptans and analgesics constituted 56.7 and 38.3% of all doses with efficacy ratios of 0.41 and 0.20, respectively. Men displayed significantly lower drug efficacy (p = 0.001), and used triptans significantly less (p < 0.001) and analgesics significantly more (p < 0.001) than women. At the end of the MBT, total drug consumption decreased by 22% (p = 0.029), corresponding to 27% fewer days with migraine headache. Drug efficacy increased during MBT from 0.30 to 0.52 (p < 0.001), mainly explained by an increased proportion of mild attacks, which also was the attack category that displayed the largest increase in drug efficacy. Conclusions: Triptans were the most used and efficient drugs. MBT led to decreased and more efficient drug consumption. Men used triptans less frequently.

Place, publisher, year, edition, pages
2012. Vol. 32, no 4, p. 297-307
Keywords [en]
drug efficacy; drug use; gender; medication; Migraine; multimodal behavioral treatment
National Category
Neurology
Identifiers
URN: urn:nbn:se:hig:diva-11757DOI: 10.1177/0333102412437386ISI: 000301518200006PubMedID: 22345630Scopus ID: 2-s2.0-84858415857OAI: oai:DiVA.org:hig-11757DiVA, id: diva2:516593
Available from: 2012-04-18 Created: 2012-04-18 Last updated: 2018-03-13Bibliographically approved
In thesis
1. Migraine and Stress: An Internet administered Multimodal Behavioral Treatment Intervention
Open this publication in new window or tab >>Migraine and Stress: An Internet administered Multimodal Behavioral Treatment Intervention
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Migraine is a disabling neurological disorder with high prevalence, the clinical manifestations of which are highly dependent on stress.

The overall theme of the present thesis was to address aspects of stress in migraine. A multimodal behavioral treatment (MBT) program was developed specifically designed for migraine and focusing on stress as a trigger and an intervention was performed using this Internet-administered program. Migraine symptoms were followed via an Internet administered diary and questionnaires were answered at regular intervals during the 11-month study period.

The thesis is based on four papers: In Paper I, life events and current stress, personality traits, and gender were studied cross-sectionally in 106 women and 44 men with migraine, who suffered at least two attacks a month at inclusion. Paper II describes a randomized controlled trial of the MBT program performed on 58 women and 25 men recruited from participants of the study described in Paper I. In the MBT study participants were randomized into one control group and two MBT groups, one of which received hand massage as part of the treatment. In Paper III, complete migraine drug use and changes in use and in drug efficacy during the MBT program were studied. In Paper IV, the salivary cortisol levels of MBT participants were evaluated as a biological stress marker.

The MBT program proved effective in decreasing migraine headache; it was feasible and there was low attrition. Moreover, MBT resulted in decreased migraine drug use and increased drug efficacy, but had no discernible effects on salivary cortisol profiles. No effect of hand massage on migraine headache frequency was seen. Personality trait profiling revealed high scores for the neuroticism factor. Stress susceptibility was the single most aberrant personality trait and correlated highly with the reported level of current stress and with experienced negative life events.

Gender differences included higher scores for women on trait anxiety, negative life events, depressive mood, anxiety, tension type headache, use of triptans, and efficacy of analgesics, whereas men displayed higher use of analgesics.

In conclusion, the efficacy and low attrition associated with the present MBT program appears promising and timely with regard to the development of better and more accessible migraine treatment. Stress susceptibility, gender, negative life events and psychosomatic comorbidity are important factors to consider in relation to the care of persons with migraine.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2011. p. 73
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 695
Keywords
Awakening Cortisol Response, Cognitive Behavioral Treatment, Gender, Hand Massage, Internet, Life Events, Migraine, Multimodal, Personality, Salivary Cortisol, Stress, Stress Marker, Stress Susceptibility
National Category
Neurology
Research subject
Neurology
Identifiers
urn:nbn:se:hig:diva-12847 (URN)978-91-554-8139-1 (ISBN)
Public defence
2011-10-14, Rosénsalen ingång 95, Barnsjukhuset, Akademiska sjukhuset, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2012-09-12 Created: 2012-09-11 Last updated: 2018-03-13Bibliographically approved

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