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"Diagnosis is not enough to make wise treatment choices; you need to know about the functional consequences of illness as well." So stated Dr. Richard B. Lipton in an interview with Reuters Health.
Dr. Lipton and several colleagues reported in the November 22/29 issue of The Journal of the American Medical Association following a study conducted with 835 adult migraineurs at 88 sites in 13 countries. This study compared step care and stratified care.
In step care, the beginning treatment is the same regardless of the level of disability the current migraine episode is causing. For this study, step care involved treating all migraines with aspirin and metoclopramide (Reglan). If relief was not achieved, zolmatriptan (Zomig) was administered.
In stratified care, the Migraine Disability Assessment Scale (MIDAS) is used to determine the level of disability caused by the episode before determining the medications to be used. For the study, those with grade II migraines were treated with the aspirin and metoclopromide regimen; grade III and IV migraines warranted treatment with zolmitriptan.
At two hours into the migraine episodes, those who were treated with step care showed 36.4% response while stratified care showed 52.7% response.
Dr. Lipton summarized, saying, "What the study shows is that in the most disabled group of migraine sufferers, the low-end therapy might only work in a quarter of patients. The question is, what is the point of giving a prescription when there's only a 1 in 4 chance."
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