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The influence of multimodal behavioral treatment on theconsumption of acute migraine drugs: a randomized, controlled study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
2012 (English)In: Cephalalgia, ISSN 0333-1024, E-ISSN 1468-2982, Vol. 32, no 4, 297-307 p.Article in journal (Other academic) Published
Abstract [en]

Objectives: To characterize overall drug use in migraine in conjunction with multimodal behavioral treatment.

Methods: 76 adults reporting at least two monthly migraine attacks underwent a randomized, controlled 24-week multimodal behavioral treatment 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 percent 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 did. At the end of multimodal behavioral treatment, total drug consumption decreased by 22 percent (p = 0.021), corresponding to 27 percent fewer days with migraine headache. Drug efficacy increased during multimodal behavioral treatment from 0.30 to 0.52 (p < 0.001), mainly explained by an increased proportion of mild attacks which also was the attack category which displayed the largest increase in drug efficacy.

Conclusions: Triptans were the most used and efficient drugs. Multimodal behavioral treatment led to decreased and more efficient drug consumption. Men used triptans less frequently.

Place, publisher, year, edition, pages
2012. Vol. 32, no 4, 297-307 p.
Keyword [en]
Migraine, medication, multimodal behavioral treatment, gender, drug use, drug efficacy
National Category
Research subject
URN: urn:nbn:se:uu:diva-157979DOI: 10.1177/0333102412437386ISI: 000301518200006OAI: oai:DiVA.org:uu-157979DiVA: diva2:437782
Available from: 2011-08-30 Created: 2011-08-29 Last updated: 2013-06-12Bibliographically 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. 73 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 695
Awakening Cortisol Response, Cognitive Behavioral Treatment, Gender, Hand Massage, Internet, Life Events, Migraine, Multimodal, Personality, Salivary Cortisol, Stress, Stress Marker, Stress Susceptibility
National Category
Research subject
urn:nbn:se:uu:diva-158079 (URN)978-91-554-8139-1 (ISBN)
Public defence
2011-10-14, Rosénsalen ingång 95, Barnsjukhuset, Akademiska sjukhuset, Uppsala, 09:15 (Swedish)
Available from: 2011-09-23 Created: 2011-08-30 Last updated: 2011-11-03Bibliographically approved

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Publisher's full texthttp://cep.sagepub.com/content/early/2012/02/15/0333102412437386.full.pdf

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