Medication Overuse Treatment Strategy Trial (MOTS):
Over seven million Americans have chronic migraine, meaning that they have 15 or more days with headaches/month, including eight or more days/month on which they have full-blown migraine attacks. One-half of people with chronic migraine take medications to abort migraine attacks too frequently, a condition that the scientific community calls “medication overuse.” Medication overuse can lead to more frequent migraines, migraines that are less responsive to other treatments, and to numerous medication-related side effects and toxicities. Despite medication overuse being exceedingly common among people who have migraine and despite the importance of offering optimal treatment to patients who overuse medication, the best treatment strategy for patients who have chronic migraine with medication overuse is uncertain.
The aim of this study is to compare two real-world strategies for treating patients who have chronic migraine with medication overuse, each with evidence for effectiveness:
- Discontinuation of the overused medication plus treatment with migraine prophylactic therapy;
- Migraine prophylactic therapy without early discontinuation of the overused medication.
Although both of these treatment strategies are commonly used, it is not known if one of these methods is superior to the other or if they provide similar outcomes. Since early discontinuation of the overused medication can result in a transient period of increased migraine pain and greater migraine-related functional impairment, if the two treatment strategies provide similar outcomes, migraine prophylactic therapy without early discontinuation of the overused medication would be the preferred treatment.