In a recent article in Neurology, investigators examined whether switching or limiting overused medications impacted preventative therapy outcomes compared with maintaining medication use levels in patients with chronic migraine and medication overuse (CMMO). It was found that outcomes of preventative migraine treatments taken without altering other symptomatic medication overuse is not inferior to a regimen where the symptomatic medication is switched. These findings were based on reductions in moderate-to-severe headache days following treatment.
The Medication Overuse Treatment Strategy clinical trial randomized patients to migraine preventative medication with or without switching overused symptomatic medications to an alternative. The alternative medication was limited to 2 treatment days per week. The second group continued the overused medication with no limits. The frequency of moderate-to-severe headache days was assessed in weeks 9 to 12 and in weeks 1 to 2 after randomization.
Among 720 participants, the baseline average number of headache days over 4 weeks was 22.5 (standard deviation [SD] 5.1), with 12.8 (SD 6.7) moderate-to-severe headache days and 21.4 (SD 5.8) days of symptomatic mediation use. The investigators observed that the non-medication switching group had noninferior results in moderate-to-severe headache day frequency during weeks 9 to 12 compared with the switching group (switching, 9.3 [SD 7.2] days vs no switching, 9.1 [SD 6.8] days; p = .75; 95% confidence interval –1.0 to 1.3). Both groups also demonstrated “similar outcomes during the first 2 weeks.”
The authors presented their results to further inform ongoing debates on the best treatment strategy for patients with CMMO. Ultimately, in the context of reducing frequency of moderate-to-severe headache days, migraine preventative medication without switching or limiting overused symptomatic medication was comparable to protocols that switched and limited medications.