Cost considerations in headache treatment. Part 1: Prophylactic migraine treatment.
Effective migraine treatment is clearly the most cost-effective in terms of both direct and indirect costs. Patient education, behavior changes, and prudent medication selection can minimize costs. Low-dose aspirin may reduce headache frequency. Among the antidepressant medications used, amitriptyine 25 mg, 3 qhs ($4.16/month) and doxepin 25 mg, 3 qhs ($10.50/month) remain the standard. Imipramine (25 mg, 3 qhs ($3.75/month) is very inexpensive and should replace nortriptyline 25 mg, 3 qhs ($64.29/month) as a second-line agent. The specific serotonin reuptake inhibitors are expensive and have no proven effect for migraine prevention. Propranolol 80 mg bid ($7.80/month) is inexpensive and frequently a good choice among beta-blockers. Atenolol 100 mg qd ($27.50/month) is less expensive than long-acting propranolol 160 mg ($35.56/month) and nadolol 120 mg qd ($43.68/month) with equivalent effectiveness. It is thus recommended as the long-acting beta-blocker of choice. Sustained-release preparations of verapamil 240 mg qd ($31.98/month) are twice the cost and less well-absorbed than the standard preparation of 120 mg bid ($17.62/month). Better information is needed concerning effectiveness and optimal dosing of some older low-cost medications in the preventive treatment of migraine.
Adelman
J U
JU
Adelman Headache Center, Greensboro, NC 27403, USA.
Von Seggern
R
R
D000319:Adrenergic beta-Antagonists / Q000191:economics / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000191:economics / Q000627:therapeutic use; D001521:Behavior Therapy / Q000191:economics; D002121:Calcium Channel Blockers / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D017048:Health Care Costs; D006801:Humans; D008881:Migraine Disorders / Q000188:drug therapy* / Q000191:economics* / Q000517:prevention & control / Q000628:therapy
D000319:Adrenergic beta-Antagonists; D000928:Antidepressive Agents; D002121:Calcium Channel Blockers