I wanted to come here each day and bring some breaking news in headache research from our recent symposium. However, combined with us being gone for a week to the meeting, then coming back for three days before the holidays, we have been overwhelmed with work. So I will add brief thoughts now and then until I can have time to write a more comprehensive article.
If there was a theme this year, it has to do with the need to be patient with therapies. As study after study was presented, each showed the maximum benefit being realized at the very end of the study, which was at the 3-month or 6-month mark.
In a perfect world, you would start a new therapy and wait six months before you consider changing. However, if that first therapy failed, and 40% do, then six months would be a long time to waste.
We tell our patients to wait at least three weeks before they even start to see improvement. Then, we often go up the dose and wait another three weeks. I am happy to say that most patients are compliant with this approach.
There are a few patients that are very impatient. Many of them have been use to getting power pain killers for years. They are use to instant gratification because pain killers help in minutes if not an hour. The only downside to pain killers for headaches, (I should say downsides as there are many), are; 1) pain killers only cover up pain and do nothing about the underlying disorder, 2) when used more than two days per week often make the disorder worse and 3) often cause addiction which complicates the headache problem substantially.
These few impatient patients often come back to the three week appointment and say, “I tried that medicine for a few days and it didn’t work so I stopped it.” We always tell patients to never stop a preventative medication before we see them back unless they have intolerable side effects.
The second related issue was a study showing how migraine disorders are cyclic. They can have bad seasons and often for no known external cause. The knee-jerk reaction is to call and say the treatment has stopped working. The advise from this study is to wait for at least three weeks to see if you don’t cycle back into to good control before you give up.