Enhancing the Effectiveness of Abortive Therapy: A Controlled Evaluation of Self‐Management Training

Abstract

Research suggests that approximately one half of recurrent headache sufferers fail to adhere properly to drug treatment regimens with as many as two thirds of patients failing to make optimal use of abortive medications such as ergotamine. In spite of these findings there are no controlled studies that have attempted to evaluate methods for improving adherence to drug regimens for the treatment of chronic headache disorders. In an initial effort to address this adherence problem thirty-four recurrent migraine sufferers were randomized to abortive therapy with ergotamine tartrate plus caffeine (standard abortive therapy) or to standard abortive therapy accompanied by a brief educational intervention designed to facilitate the migraine sufferer's effective use of ergotamine. Patients who received the adjunctive educational intervention attempted to abort a greater percentage of their migraine attacks (70% vs 40%) and showed larger reduction in headache activity (e.g., 40% vs 26% reduction in month two of treatment). However, patients in both treatment groups used similar amounts of abortive medication when attempting to abort a migraine attack and showed similar reductions in analgesic medication use with abortive therapy. There results suggest that brief educational interventions designed to address the problem of patient adherence may yield significant improvements in standard therapies. We argue that such educational interventions deserve more attention in the headache treatment literature than they have received to date.

Behavioral interventions for tension-type headache: Overview of current therapies and recommendation for a self-management model for chronic headache

“…To our knowledge, only one study has evaluated a selfmanagement intervention to improve adherence with pharmacotherapy (abortive treatment) for headache [50]. Seventy percent of patients were identified as failing to make optimal use of ergotamine for migraine.…”

“…With a brief behavioral intervention, adherence failures declined in four categories: failure to take medication because it was unavailable to the patient; failure to take medication sufficiently early in headache episode to be effective; ingestion of ergotamine on an empty stomach, which resulted in nausea and a decreased likelihood of subsequent use; and medication overuse. In the study by Holroyd et al [50], patients in the adherence-enhancing group participated in a 30-minute education session and received three brief phone calls to identify and remedy problems with medication use. They also were provided a self-management workbook to assist the patient in monitoring and identifying adherence problems, improving decision-making, and correcting adherence problems.…”

Behavioral medicine for migraine and medication overuse headache

“…In fact, improper timing may be one of the factors leading to overuse. Specifi c, detailed education can signifi cantly improve self-dosing and resultant effectiveness for both migraine without and with medication overuse [20].…”

Application of behavioral therapies in adult and adolescent patients with chronic migraine

“…There is a vast literature that concludes that many of these patients fail to take abortive medications [26,27] and preventive medications [28,29] as prescribed. Treatment drop-out and inconsistency in appointment keeping may be problems for the treating clinician.…”