Prophylaxis of Migraine and Mixed Headache. A Randomized Controlled Study

Abstract

SYNOPSIS The three most commonly used modalities in the prophylactic treatment of headache, namely propranolol, amitriptyline and biofeedback training, were compared individually and in combination. Three hundred forty patients with migraine end 375 patients with mixed headache were randomly allotted to 8 therapeutic categories. The total duration of the study was 312 years and the therapeutic groups were evaluated for a period of 7 months including I month of pretreatment observation. Improvement was assessed by percentage of change in the average headache index during the last three months of evaluation from the pretreatment headache index. In the migraine group 273 patients completed the study. Improvement was significantly higher in patients receiving prophylactic treatment compared to control patients who were on abortive Ergotamine treatment. Propranolol plus biofeedback yielded the best results in the migraine group and addition of amitriptyline did not significantly change the percentage of improvement. Propranolol alone (62%) was significantly superior to amitriptyline (42%) (p < 0.01). The differences between propranolol alone and propranolol plus amitriptyline was not statistically significant. In the mixed headache group 281 patients completed the study. The most effective treatment was combination of amitriptyline, propranolol and biofeedback training. Amitriptyline alone was superior to propranolol alone in the treatment of mixed headache (p<0.01). A combination of propranolol and amitriptyline was superior to either of those alone. Biofeedback, though by itself, did not appear to be the treatment of choice, significantly contributed to better results as an adjunct when it is combined with pharmacological agents. Concomitant use of propranolol and amitriptyline did not result in any adverse reactions or clinical incompatibility.

Reach and representativeness of ethnic minority women in the Health Is Power Study: a longitudinal analysis

“…Among African American and Hispanic or Latina women in this sample, only about one in five of the women who were originally recruited were retained at the primary outcome measurement endpoint, which is consistent with other randomized controlled trials in the behavioral and clinical sciences [12,14,19,46,47]. Also, similar to other studies, most participants dropped out early in the process, owing likely to both the complexity of behavior change and the efficacy of strategies employed herein to encourage drop out early in the study [48][49][50][51].…”

Transformation of Episodic Migraine Into Daily Headache: Analysis of Factors

“…(2) Biofeedback training using EMG feedback, temperature training, a relaxation training, lead not only to similar reductions in headache within the groups of migraine and muscle contraction headache but also similar reductions in headache across the diagnostic groups. (3) Some of the drugs used in the successful treatment of headache such as propranolol, amitriptyline 9 have little or no action on skeletal muscle contraction. In fact, these drugs have central action, mostly on monoamine metabolism and receptors.…”

Propranolol vs flunarizine vs flunarizine plus propranolol in migraine without aura prophylaxis. a double-blind trial

“…Moreover, usually there are patients who do not respond to one or more prophylactic drugs. Besides, there are individual differences in the responsiveness to different prophylactic agents and even sometimes, an inability to sustain an initial good response to a particular agent 8 . Such facts may be arguments for the concomitant use of two modalities of drugs in migraine prophylaxis.…”