Intended Audience
This activity was developed for neurologists and headache specialists who treat patients with chronic migraine (CM).
Statement of Need
CM is a neurologic disorder with heterogeneous characteristics resulting in a wide range of symptoms and varying degrees of burden and disability. CM affects nearly 12% of the adult population in Western countries, imposing considerable economic and social losses. Although this disorder is highly prevalent and disabling, it remains largely undiagnosed and undertreated.
CM is now recognized as one of 4 types of primary chronic daily headache (CDH) of long duration. It is a syndrome defined by primary headache 15 days or more per month for at least 3 months, with attacks that last 4 hours or more per day on average. The other forms of CDH of long duration include chronic
tension-type headache, new daily persistent headache, and hemicrania continua. CM typically evolves from episodic migraine over months to years in susceptible individuals. Headaches increase in frequency over time, becoming less intense but more disabling and less responsive to treatment.
To date, there are no FDA-approved treatments for CM prophylaxis. Treatment techniques for CM such as the application of cold or hot packs, ultrasonography, and electrical stimulation have been shown to lessen pain. Investigational nonpharmacologic treatments, such as cognitive behavioral therapy, stress management, and biofeedback, have proved effective in some areas of pain management, including migraine. Nonetheless, pharmacologic interventions may be necessary for long-term, efficacious prophylaxis. Several classes of medications for depression, convulsions, and blood pressure control are also used for headache pain management in some patient populations. The results of clinical trials of certain investigational medications are supportive of their use in CDH prophylaxis. However, the significance of these findings is limited by several factors, including small numbers of patients, the choice of efficacy measures, and short treatment periods. In addition, the use of these medications has been associated with systemic side effects, which may limit their effectiveness for prophylactic treatment of CDH and, in some cases, prevent their continued use. The development of effective agents for CM with minimal adverse effects, through large randomized, controlled clinical trials, is imperative for patients who suffer from this condition. In this symposium, published data comparing the clinical trials of various classes of current and future prophylactic treatment options for this debilitating disorder will be reviewed.
References
Krymchantowski AV, Rapoport AM, Jevoux CC. The future of acute care and prevention in headache. Neurol Sci. 2007;28(suppl 2):S166-S178.
Lipton RB, Bigal ME, Steiner TJ, et al. Classification of primary headaches. Neurology. 2004;63:427-435.
Olsen J, Steiner TJ. The international classification of headache disorders, 2nd ed (ICDH-II). J Neurol Neurosurg Pyschiatry. 2004;75:808-811.
Stewart WF, Shechter A, Lipton RB. Migraine heterogeneity, disability, pain intensity, and attack frequency and duration. Neurology. 1994;44:S24–S39.
Learning Objectives
At the conclusion of this activity, participants should be better able to:
Accreditation and Certification
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the Annenberg Center for Health Sciences at Eisenhower and CogniMed Inc. The Annenberg Center is accredited by the ACCME to provide continuing medical education for physicians.
The Annenberg Center designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
There is no charge for this activity. Statements of Credit will be provided by mail following activity participation and upon completion and electronic submission of the posttest and evaluation form to CogniMed Inc. A link to the evaluation form is available upon completion of the activity, or please click here to access the evaluation form. Please allow 4 to 6 weeks for the delivery of your statement.
Faculty
David W. Dodick, MD, FRCP (C), FACP
Chairperson
Professor of Neurology
Mayo Clinic College of Medicine
Scottsdale, Arizona
Andrew C. Charles, MD
Professor and Vice Chair
Director, Headache Research and Treatment Program
Department of Neurology
David Geffen School of Medicine at UCLA
Los Angeles, California
Stephen D. Silberstein, MD, FACP
Professor of Neurology
Department of Neurology
Jefferson Medical College of Thomas Jefferson University
Director
Jefferson Headache Center
Philadelphia, Pennsylvania
Disclosure Statement
It is the policy of the Annenberg Center to ensure fair balance, independence, objectivity, and scientific rigor in all programming. All faculty participating in sponsored programs are expected to identify and reference off-label product use and disclose any significant relationships with those supporting the activity or any others whose products or services are discussed.
In accordance with the Accreditation Council for Continuing Medical Education standards, parallel documents from other accrediting bodies, and Annenberg Center policy, the following disclosures have been made:
All staff at the Annenberg Center for Health Sciences at Eisenhower have nothing to disclose.
All staff at CogniMed Inc. have nothing to disclose.
Andrew C. Charles, MD, receives research support from Minster Pharmaceuticals. He serves on advisory panels for AGA and Merck & Co., Inc., and the speakers bureau of Merck & Co., Inc.
David W. Dodick, MD, FRCP (C), FACP, receives research support from Advanced Neuromodulation Systems, Inc.; Mayo Clinic; Medtronic, Inc.; National Institute of Neurological Disorders and Stroke; and St. Jude Medical, Inc. He receives honoraria and is a consultant for Addex Pharmaceuticals; Alexza Pharmaceuticals, Inc.; Allergan, Inc.; Almirall; Coherex Medical, Inc.; Eli Lilly and Company; Endo Pharmaceuticals Inc.; GlaxoSmithKline; H. Lundbeck/Kowa Company Ltd.; MAP Pharmaceuticals, Inc.; Medtronic, Inc.; Merck & Co., Inc.; Minster Pharmaceuticals; Neuralieve Inc.; NeurAxon; Novartis; NuPathe Inc.; and Pfizer Inc.
Stephen D. Silberstein, MD, FACP, receives research support from Advanced Neuromodulation Systems, Inc.; AGA; Allergan, Inc.; Boston Scientific Corporation; Coherex Medical, Inc.; Eli Lilly and Company; Endo Pharmaceuticals Inc.; GlaxoSmithKline; MAP Pharmaceuticals, Inc.; Medtronic, Inc.; Merck & Co., Inc.; NuPathe Inc.; and Valeant Pharmaceuticals International. He is a consultant for or serves on the advisory panels or speakers bureaus of AGA; Allergan, Inc.; CAPNIA Incorporated; Coherex Medical, Inc.; Endo Pharmaceuticals Inc.; GlaxoSmithKline; MAP Pharmaceuticals, Inc.; Medtronic, Inc.; Merck & Co., Inc.; NuPathe Inc.; and Valeant Pharmaceuticals International.
The ideas and opinions presented in this educational activity are those of the faculty and do not necessarily reflect the views of the Annenberg Center and/or its agents. As in all educational activities, we encourage the practitioners to use their own judgment in treating and addressing the needs of each individual patient, taking into account that patient’s unique clinical situation. The Annenberg Center disclaims all liability and cannot be held responsible for any problems that may arise from participating in this activity or following treatment recommendations presented.
The American Headache Society does not endorse products discussed in this activity.
This activity is supported by an independent educational grant provided by Allergan, Inc.
This activity is an enduring material and consists of a Web posting. Successful completion is achieved by viewing the material, reflecting on its implications in your practice, and completing the assessment component.
The estimated time to complete this activity is 1.5 hours.