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This Week in JAMA
November 22/29, 2000

This Week in JAMA

JAMA. 2000;284(20):2559. doi:10.1001/jama.284.20.2559

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.