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In this trial, Lipton and colleaguesArticle compared 3 strategies for the treatment
of up to 6 migraine attacks: step care within attacks using aspirin plus metoclopramide
for each attack and zolmitriptan if no response after 2 hours; step care across
attacks using aspirin plus metoclopramide for the first 3 attacks, then zolmitriptan
as initial therapy for attacks 4 through 6 if the response for 2 of the first
3 attacks was unsatisfactory; and stratified care based on MIDAS disability
levels (for MIDAS grade II disability, aspirin plus metoclopramide for all
attacks; for MIDAS grade III or IV, zolmitriptan for all attacks). Headache
response at 2 hours was significantly better among patients who received stratified
care compared with both step care strategies, and disability time over 4 hours
was significantly less. In an editorial, Matchar and coauthorsArticle note that this
trial provides evidence to support US Headache Consortium guidelines for the
selection and sequencing of treatments for acute migraine.
This Week in JAMA. JAMA. 2000;284(20):2559. doi:10.1001/jama.284.20.2559
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