1. Table 2 Migraine Treatments Migraine Treatments by clinical setting
Migraine Treatment Optimization in Multiple Sclerosis
Soma Sahai-Srivastava, M.D, Shirley L Wang, M.D, Ceren Ugurlu, M.D, Lilyana Amezcua, M.D. Department of Neurology, University of Southern California, Los Angeles, California
Background
Table 2 Migraine Treatments
n (%)
Abortive
57(69)
NSAID
TRIPTAN
CAFFEINE
OPIOID
56(57)
10(10)
5(5)
Preventative
12(14)
Preventative and Abortive
Antiepileptic
Antidepressant
11(13)
6(7)
Alternative/Lifestyle
58(70)
Cold cloth/ice pack to forehead, lie down in dark quiet room, sleep
47(57)
Relaxation
16(19)
Tea/herb
10(12)
Muscle relaxation/ biofeedback
4(5)
Migraine is under diagnosed and under treated in the general population. Primary headaches, especially migraine headaches are more prevalent in Multiple Sclerosis (MS) patients than the general population. Migraine may be associated with more symptomatic course in MS patients. Migraine Treatment Optimization Questionnaire (M-TOQ) is a validated 5 item quick tool that can identify patients requiring change in their acute treatment.
Table 3
Migraine T/t by clinic setting
Private Clinic
n (%)
Public Clinic
n(%)
Optimized T/t
29(66)
19(49)
Abortive
30(68)
27(69)
Preventative
7(16)
5(13)
Alternative
28(64)
30(77)
Table 4
Migraine Treatments by clinical setting
Private Clinic
n (%)
Public Clinic
n(%)
Abortive
NSAID
TRIPTAN
CAFFEINE
OPIOID
30(39)
8(10)
2(3)
4(5)
26(61)
2(5)
3(7)
1(2)
Preventative
Antiepileptic
Antidepressant
3(6)
4(9)
Methods
Cross sectional interview based study of 233 consecutive MS patients. Detailed questionnaires, M-TOQ and HIT-6 was used.
Results
Conclusion: 50% MS migraineurs non optimized treatments regardless of migraine regimen, race or walking disability.
56% of MS patients with headache are moderately/severely impact in daily life (HIT-6).
Optimized t/t higher in private clinic; Alternative t/t was more common in public clinic.
Abortive treatment was similar regardless of treatment setting
We recommend M-TOQ in clinical practice for patients with MS with migraines
Total n=233
n (%)
Female
156(67)
Mean Age
40.5
Headache
115(50)
Migraine
83(36)