Repetitive preventive treatment in long-term relief from migraine
NIKOLAKAKI E., KOUROUMALOS N., KORAKAKI D., KALAMAFKIANAKI K.,
LABIRIS C., KARATZAFERIS L., ANDRINOS D., KONTOGEORGAKI M., GEORGAKAKIS G.

Observing migraine (M) attacks worsening or reccurring at variable times after ending prophylactic treatment (PT) generated the idea that it might benefit patients, if repetitive doses of the medication used for prophylaxis were given at intervals after withdrawal from initial PT.

Thus, we thought of re-administering the prophylactic medication after cessation of initial PT. This would be done at short intervals over time, and a much lower amount of medication would be used than that during initial PT. We called this "repetitive PT for M".

The aim of this study was to check the efficacy of repetitive PT in long-term relief from migraine.

In a retrospective study, the files of 83 patients suffering from M (using ICHD 1988 criteria) were initially examined with reference to:

a) Whether patients received any initial PT for M for a period of 6 to 10 months.

b) Whether they were followed up for a period of 24 to 36 months after the end of initial PT.

Those were then divided into 2 groups:

1. 39 patients that took repetitive PT for M, and
2. 44 patients that did not take repetitive PT and were used as a control group.

Group 1 after the end of initial PT, abstained for two months from the medication which was used at the initial PT. Then the patients were subjected to the following 6-week therapeutic scheme:

• For the first 4 weeks patients were given the agent they were taking as initial PT at the maximal daily dose that was reached during initial PT.
• For the next 2 weeks they were administered half of that dose daily.

Treatment was then again discontinued for another 3 months. After that, they repeated the above scheme and then abstained from the drug for another 6 months.

Thereafter, patients repeated the scheme once every 6 months for the remaining time of the overall 24-36 month follow-up period.

Headache frequency (HF) in days per month, headache duration (HD) in hours per day and headache intensity (HI) using a 0-10 scale were then measured among patients in both groups during the follow-up period.

All 39 patients who took repetitive PT maintained the result that was achieved by the end of initial PT throughout the 24-36 month follow-up period (Group 1).

Among the 44 patients who did not take repetitive PT, rebound of M occurred with respect to frequency, duration and intensity within the same period (Group 2).

Most of them needed to start full-time PT again.

Throughout the 24-36 month follow-up period:

• Among Group 1:
  48.7 %: had no headache
  38.5 %: had less than1 headache days per month, with duration of less than 6 hours per day.
  12.8 %: 1-2 headache days per month, with duration of less than 12 hours per day.
  Out of those patients with headache days, those who were not free of headache scored higher than 5 in a scale of 0-10 as regards Headache Frequency.
• Among Group 2:
  54.5 %: had less than 5 headache days per month
  45.5 %: had 6-12 headache days per month.
  Concerning Headache Duration:
  79.5% had less than 10 hours per day
  20.5% had less than 24 hours per day.
  Concerning Headache Intensity:
  54.5% scored lower than 7
  25% scored 7,
  20.5% scored between 7 and 10.
  Interestingly enough, 39 patients on repetitive PT maintained the result achieved by initial PT for 2-3 years. Among the rest 44, M either re-appeared or worsened within the same time.

We are aware of no similar studies. Nevertheless, further studies with more patients are needed to prove the efficacy of repetitive PT.

Key words: Preventive, prophylactic, anamnestic, repetitive migraine therapy.