title: Effect of preventive (beta blocker) treatment, behavioural migraine management, or their combination on outcomes of optimised acute treatment in frequent migraine: randomised controlled trial.
abstract: OBJECTIVE
  To determine if the addition of preventive drug treatment (β blocker), brief behavioural migraine management, or their combination improves the outcome of optimised acute treatment in the management of frequent migraine.
  
  
  METHODS
  Randomised placebo controlled trial over 16 months from July 2001 to November 2005.
  
  
  METHODS
  Two outpatient sites in Ohio, USA.
  
  
  METHODS
  232 adults (mean age 38 years; 79% female) with diagnosis of migraine with or without aura according to International Headache Society classification of headache disorders criteria, who recorded at least three migraines with disability per 30 days (mean 5.5 migraines/30 days), during an optimised run-in of acute treatment.
  
  
  METHODS
  Addition of one of four preventive treatments to optimised acute treatment: β blocker (n=53), matched placebo (n=55), behavioural migraine management plus placebo (n=55), or behavioural migraine management plus β blocker (n=69).
  
  
  METHODS
  The primary outcome was change in migraines/30 days; secondary outcomes included change in migraine days/30 days and change in migraine specific quality of life scores.
  
  
  RESULTS
  Mixed model analysis showed statistically significant (P≤0.05) differences in outcomes among the four added treatments for both the primary outcome (migraines/30 days) and the two secondary outcomes (change in migraine days/30 days and change in migraine specific quality of life scores). The addition of combined β blocker and behavioural migraine management (-3.3 migraines/30 days, 95% confidence interval -3.2 to -3.5), but not the addition of β blocker alone (-2.1 migraines/30 days, -1.9 to -2.2) or behavioural migraine management alone (-2.2 migraines migraines/30 days, -2.0 to -2.4), improved outcomes compared with optimised acute treatment alone (-2.1 migraines/30 days, -1.9 to -2.2). For a clinically significant (≥50% reduction) in migraines/30 days, the number needed to treat for optimised acute treatment plus combined β blocker and behavioural migraine management was 3.1 compared with optimised acute treatment alone, 2.6 compared with optimised acute treatment plus β blocker, and 3.1 compared with optimised acute treatment plus behavioural migraine management. Results were consistent for the two secondary outcomes, and at both month 10 (the primary endpoint) and month 16.
  
  
  CONCLUSIONS
  The addition of combined β blocker plus behavioural migraine management, but not the addition of β blocker alone or behavioural migraine management alone, improved outcomes of optimised acute treatment. Combined β blocker treatment and behavioural migraine management may improve outcomes in the treatment of frequent migraine.
  
  
  BACKGROUND
  Clinical trials NCT00910689.
authors.affiliation: Ohio University, Athens, OH 45701, USA. holroyd@ohio.edu
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Holroyd
authors.forename: Constance K
authors.initials: CK
authors.lastname: Cottrell
authors.forename: Francis J
authors.initials: FJ
authors.lastname: O'Donnell
authors.forename: Gary E
authors.initials: GE
authors.lastname: Cordingley
authors.forename: Jana B
authors.initials: JB
authors.lastname: Drew
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Carlson
authors.forename: Lina
authors.initials: L
authors.lastname: Himawan
mesh_terms: D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D001521:Behavior Therapy / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D008881:Migraine Disorders / Q000517:prevention & control*; D011788:Quality of Life; D055502:Secondary Prevention; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000319:Adrenergic beta-Antagonists