{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T10:45:15Z","timestamp":1766486715744,"version":"build-2065373602"},"reference-count":46,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2015,4,17]],"date-time":"2015-04-17T00:00:00Z","timestamp":1429228800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Ortho-McNeil Neurologics, Inc., Titusville, NJ"},{"name":"MAP Pharmaceuticals, Mountain View, CA"},{"name":"Allergan Inc., Irvine, CA"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Headache"],"published-print":{"date-parts":[[2015,6]]},"abstract":"\n Background<\/jats:title>\n Though triptans are the most widely used acute treatments for migraine, response to treatment is sometimes suboptimal. Triptan therapy is often augmented by the addition of other acute treatments. The benefits of this practice have not been examined in large\u2010scale, real\u2010world observational studies.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n \n To assess changes in headache\u2010related disability associated with adding additional acute treatments to a triptan regimen by category of added treatment including: a second triptan, nonsteroidal anti\u2010inflammatory drugs (\n NSAID<\/jats:styled-content>\n ), opioids or barbiturates.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Subjects were participants in the American Migraine Prevalence and Prevention study, a longitudinal,\n US<\/jats:styled-content>\n population\u2010based study of individuals with \u201csevere\u201d headache. Respondents who met International Classification of Headache Disorders 3 beta criteria for migraine were on triptan therapy per respondent self\u2010report, used the same triptan, and provided headache\u2010related disability data for at least 2 consecutive years. Subjects were divided based on headache days per month into 3 groups: low\u2010frequency episodic migraine (\n LFEM<\/jats:styled-content>\n , 0\u20104), moderate\u2010frequency episodic migraine (\n MFEM<\/jats:styled-content>\n , 5\u20109), and high\u2010frequency episodic migraine\/chronic migraine (\n HFEM<\/jats:styled-content>\n \/\n CM<\/jats:styled-content>\n ,\u2009\u2265\u200910 headache days per month).\n HFEM<\/jats:styled-content>\n and\n CM<\/jats:styled-content>\n were combined into a single group for analyses because of sample size limitations. Patterns of acute treatment for migraine were monitored from one year to the next over the following couplets of years (2005\u20102006, 2006\u20102007, 2007\u20102008, and 2008\u20102009). The first eligible couplet was analyzed for each respondent. Medication regimens studied included: (1) maintaining current triptan use (consistent group); (2) adding a different triptan; (3) adding an\n NSAID<\/jats:styled-content>\n ; or (4) adding a combination analgesic containing opioids or barbiturates. We assessed change in\n M<\/jats:styled-content>\n igraine\n D<\/jats:styled-content>\n isability Assessment (\n MIDAS<\/jats:styled-content>\n ) score from the first to the second year of a couplet, contrasting scores of participants with consistent use with those who added an acute treatment to their triptan regimen.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The study sample (N\u2009=\u20092128) included 111 individuals who added another triptan, 118 who added an opioid or barbiturate, and 69 who added an\n NSAID<\/jats:styled-content>\n , with referent groups of approximately 600 cases in each group who remained consistent. In general,\n MIDAS<\/jats:styled-content>\n scores were higher among those who made changes from one year to the next compared with those who did not make changes in therapy. In fully adjusted models, adding triptans or\n NSAIDs<\/jats:styled-content>\n was associated with increased disability for\n HFEM<\/jats:styled-content>\n \/\n CM<\/jats:styled-content>\n cases at follow\u2010up but decreased disability at follow\u2010up for\n MFEM<\/jats:styled-content>\n cases, resulting in significant interaction effects for both adding triptans and\n NSAIDs<\/jats:styled-content>\n , respectively (15.88, 95% confidence interval [\n CI<\/jats:styled-content>\n ] 0.75, 31.01, 38.52, 95%\n CI<\/jats:styled-content>\n 12.43, 64.61).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n While the effects of adding vs staying consistent on the outcome of headache\u2010related disability varied by medication type added and headache frequency strata, in general, these results suggest that for individuals with migraine, adding acute therapies to current triptan use is generally not associated with reductions in headache\u2010related disability. The results were strongest among persons with\n HFEM<\/jats:styled-content>\n and\n CM<\/jats:styled-content>\n . These results identify important unmet medical needs in current migraine management, especially among patients with high\u2010frequency migraine, and suggest that alternative treatment strategies are needed to improve patient outcomes.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/head.12556","type":"journal-article","created":{"date-parts":[[2015,4,17]],"date-time":"2015-04-17T02:53:36Z","timestamp":1429239216000},"page":"825-839","source":"Crossref","is-referenced-by-count":20,"title":["Adding Additional Acute Medications to a Triptan Regimen for Migraine and Observed Changes in Headache\u2010Related Disability: Results From the American Migraine Prevalence and Prevention (\n AMPP<\/scp>\n ) Study"],"prefix":"10.1111","volume":"55","author":[{"given":"Dawn C.","family":"Buse","sequence":"first","affiliation":[{"name":"Albert Einstein College of Medicine Bronx NY USA"},{"name":"Montefiore Headache Center Bronx NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Serrano","sequence":"additional","affiliation":[{"name":"Albert Einstein College of Medicine Bronx NY USA"},{"name":"Endpoint Outcomes Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael L.","family":"Reed","sequence":"additional","affiliation":[{"name":"Vedanta Research Chapel Hill NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shashi H.","family":"Kori","sequence":"additional","affiliation":[{"name":"Formerly of Allergan Inc. 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