There are many treatment options available for migraine prevention that have good data to support their effectiveness. But we know it is sometimes difficult to find the right dose of the right medication for an individual patient. There is no cookbook recipe or one-size-fits-all approach for doctors to follow when recommending migraine prevention medications. So prescribing them takes a lot of listening, thought, and follow up to ensure that the benefit is clear and side effects are not going to be a problem. Unfortunately, in today’s medical practices, most doctors don’t have the necessary time to manage these situations with the attention they require. And the result is all too often treatment failure. To make matters worse, currently used preventive medications for migraine were all invented for another reason and found to reduce migraine attacks after the fact. They include drugs that treat seizures, depression, and high blood pressure, to name a few. They all have side effect concerns and drug interaction warnings. And many times they don’t work very well for a given migraine sufferer.

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So maybe it will come as no surprise that adherence to migraine prevention medications is unacceptably low. But that’s what a group of researchers reported in the October Journal of Headache (Headache. 57:1399-1408). The team led by Dr Robert Lenz, from Amgen, reviewed insurance claims data for over 100,000 patients with migraine who received a migraine prevention prescription from 2008 to 2011. Shockingly, 81% of those patients had gaps in treatment lasting more than 3 months within the first year of starting them. And after a year, 65% were not receiving any migraine prevention medications at all. Not a very good track record to say the least! Unfortunately claims data doesn’t tell us why patients stopped their medications. But the authors speculate that the likely causes were side effects, lack of effectiveness, and in some instances perhaps cost. I can’t help but wonder how many could have gotten better results with closer follow up and active management of the medications with their doctors. I guess we will never know. But I suspect the difference could be significant.

Thankfully, we are on the verge of seeing new treatments coming on the market within the next year which will be safe, highly effective for many, and migraine specific in their action. And additional molecular targets to relieve migraine suffering are in the pipeline and hopefully will give us more options in the coming years. I would dare to say, that the treatment of migraine will look starkly different in the next 5 to 10 years compared to today. So there is great cause to be hopeful! Clinical trials are ongoing for these new, cutting-edge treatments and volunteers are needed. Contact a research facility near you to find out more about current or upcoming studies. Being in a clinical trial may well bring help to the volunteer. But more importantly, that volunteerism contributes to new medicine development that may go on to help thousands of others as well! Without research volunteers we would have no new medications at all. In the St Louis area, call StudyMetrix Research at 636.387.5100, email us at, check out our website at, or follow us on Facebook to learn more about research volunteer opportunities.

Take care of yourselves, and be well!

Timothy R Smith, MD, RPh


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