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Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.

New and Emerging Therapies in the Treatment of Migraine

To provide physicians with up-to-date information on the prevention and treatment of migraine with a focus on new and emerging therapies such as antiepileptic drugs.

This activity is designed for neurologists, particularly those who treat patients with migraine.

After reading this Special Report, the participant should be able to:

  • Identify and distinguish among frequent headache, transformed migraine, chronic daily headache, chronic tension-type headache, and their treatment protocols.
  • Describe the appropriate use of antiepileptic drugs for the treatment of migraine.
  • Explain the relationship between gamma-aminobutyric acid (GABA) and migraine headache.

The Johns Hopkins University School of Medicine designates this continuing medical education activity for up to 2 credit hours in Category 1 of the Physician’s Recognition Award of the American Medical Association. Each physician should claim only those hours of credit that he or she actually spends on the educational activity. Credits are available until the expiration date of January 31, 2003.

The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians. This continuing education activity was planned and produced in accordance with the ACCME Essentials and Standards for Commercial Support.

This continuing education activity was produced under the supervision of Brian E. Mondell, MD, Medical Director, Baltimore Headache Institute, and Assistant Professor of Neurology, Johns Hopkins University School of Medicine.

This program is supported by an unrestricted educational grant from Ortho-McNeil Pharmaceutical, Inc.

Publisher’s Note and Disclaimer: The opinions expressed in this Special Report are those of the authors, presenters, and/or panelists and are not attributable to the sponsor or the publisher, editor, advisory board of Advanced Studies in Medicine, or The Johns Hopkins University School of Medicine or Office of Continuing Medical Education. Clinical judgment must guide each professional in weighing the benefits of treatment against the risk of toxicity. Dosages, indications, and methods of use for products referred to in this Special Report are not necessarily the same as indicated in the package insert for the product and may reflect the clinical experience of the authors, presenters, and/or panelists or may be derived from the professional literature or other clinical sources. Consult complete prescribing information before administering.

The proceedings of this issue of Advanced Studies in Medicine are based on the symposium, Headache World 2000, held in London, September 3-7, 2000.


    Mary G. Gabb, MS
    Medical Writer/Editor
    Champaign, Illinois
    • Ms. Gabb reports no financial relationship with any pharmaceutical company.

    Richard B. Lipton, MD
    Department of Neurology Epidemiology, and Social Medicine
    Albert Einstein College of Medicine
    New York, New York
    Innovative Medical Research
    Stamford, Connecticut
    • Dr. Lipton receives research funding, lecture honoraria, and consulting fees from most pharmaceutical manufacturers of headache products.

    Ann Scher, MS
    Department of Epidemiology
    Johns Hopkins University
    Baltimore, Maryland
    • Ms. Scher receives research support from Glaxo Wellcome.

    Stephen D. Silberstein, MD
    Thomas Jefferson Headache Center and Department of Neurology
    Thomas Jefferson University Hospital
    Philadelphia, Pennsylvania
    • Dr. Silberstein serves as an advisor to Novartis, Abbott, Glaxo Wellcome; a speaker for Abbott and Merck; and receives research support from Bristol-Myers Squibb, Zeneca, SmithKline Beecham, Merck, Janssen, Johnson & Johnson, Wyeth-Ayerst, Cocensys, and Lilly.

    Walter F. Stewart, PhD, MPH
    Innovative Medical Research
    Stamford, Connecticut
    Department of Epidemiology
    Johns Hopkins University
    Baltimore, Maryland
    • Dr. Stewart receives research support from Pharmacia, Lillly, Astra-Zeneca, and Schering-Plough, and serves as a consultant to Novartis.

    R. James Storer, PhD
    Institute of Neurology Department of Clinical Neurology
    University College London
    University of London
    London, England
    • Dr. Storer receives grant support from Glaxo Wellcome Research and Development, United Kingdom. Holli A. Carlson and Stephen D. Collins, MD, PhD, are employees of Abbott Laboratories.

Advanced Studies in Medicine provides disclosure information from contributing authors, participating faculty, and presenters only. Advanced Studies in Medicine does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.

New and Emerging Therapies in the Treatment of Migraine
Brian E. Mondell, MD

This issue of Advanced Studies in Medicine is the first in a series of 3 publications focusing on new and emerging treatments for migraine. The proceedings in this month's issue are based on the meeting Headache World 2000 (HW2K), held in London, England, September 3-7, 2000. The meeting was unique in that it combined several leading international conferences:

  • The Thirteenth Migraine Trust International Symposium
  • First Global Convention of the World Headache Alliance
  • Millennial International Headache Congress of the International Headache Society
  • The Fifth European Headache Federation Congress.

It was organized by the British Association for the Study of Headache and cosponsored by the World Health Organization. It was also part of the program for the Millennium Festival of Medicine (coordinated by the British Medical Association).

HW2K assembled researchers and clinicians from many scientific disciplines to address migraine and headache disorders. The conference organizers sought to use the millennium as an opportunity for not only assessing our progress but also, and more importantly, for casting aside stale mindsets and for doing things differently.

The mission of HW2K is intricately linked to the benefit of those with migraine and other headache disorders, from the point of view of the scientist, clinician, caregiver, or sufferer. In fact, a parallel track Public Program was created for members of the general public to interact with the delegates. In this way, patients could better understand their disease, the focus of future therapies, and the challenges faced by the medical and research communities. It also rein- forced to the public the dedication of migraine and headache researchers to improving the lives of migraine and headache sufferers. This attention to the public culminated in 1 of 2 joint plenary sessions with the Scientific and Public Programs, for which the Migraine Trust Lecture was delivered by Dr. Richard B. Lipton. 'Frequent Headache: A Far Too Common Problem in this issue is based on that lecture.

The conference covered the spectrum of medical science in migraine and other headache disorders: genetics, epidemiology, classification, pathophysiology and imaging, prevention, and management. It also sought to answer the question: what do migraine patients want from their doctors?

Increasing focus is being placed on prevention. While the triptans have offered a breakthrough in treatment options for migraineurs, there remain a subset of patients for whom they are not effective. Also, some patients prefer to avoid migraine, rather than treat it once it begins. As a result, significant effort and advances have been made in trying to understand the very complicated pathophysiology of onset of these disorders.

For preventive therapy, antiepileptic drugs (AEDs) are clearly gaining attention. Several are under investigation, including both first- and second-generation AEDs and cousin compounds. The clinical data presented at this conference were obtained through safety and efficacy trials. New formulations of AEDs were also tested for better tolerability.

In addition to the burden of frequent headache, the Migraine Trust Lecture and other presentations discussed the usefulness of the diagnostic criteria published by the International Headache Society. It is clear that migraine and some other headache disorders are a continuum, so classification criteria may need to evolve to identify those along the continuum. Appropriate classification can impact treatment decisions, reimbursement policies, and allocation of research money.

This issue provides highlights of HW2K, focusing on the role of AEDs in the prevention and treatment of migraine and other headache disorders and the burden of migraine and headache disorders.

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