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Tolerance and Loss of Beneficial Effect During Migraine Prophylaxis: Clinical Considerations.

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Title: Tolerance and Loss of Beneficial Effect During Migraine Prophylaxis: Clinical Considerations.
Authors: Loder, Elizabeth W., Rizzoli, Paul
Source: Headache: The Journal of Head & Face Pain. Sep2011, Vol. 51 Issue 8, p1336-1345. 10p.
Subjects: Migraine prevention, Drug tolerance, Migraine, Research funding, Disease relapse, Disease progression
Abstract: A familiar situation in migraine treatment is the patient with an initial positive response to prophylactic drug therapy who later experiences relapse. The goals of this paper are to provide a theoretical framework to help doctors think about this problem, to evaluate factors and response patterns that may be associated with different causes of relapse, and to suggest clinical strategies that may aid in its management. Six key explanations for loss of benefit from prophylactic therapy are: (1) pharmacokinetic, pharmacodynamic, and behavioral drug tolerance; (2) non-specific or placebo effects; (3) natural variability in disease activity; (4) disease progression; (5) inaccurate recall of treatment effects; and (6) drug delivery problems. Current options for patients who experience loss of benefit from prophylactic therapy include traditional techniques such as switching, re-trying, rotating, or combining drugs. Selected behavioral and environmental treatment techniques might also be useful. We describe a practical, structured approach to evaluation and management of relapse with migraine prophylaxis. [ABSTRACT FROM AUTHOR]
Copyright of Headache: The Journal of Head & Face Pain is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Tolerance and Loss of Beneficial Effect During Migraine Prophylaxis: Clinical Considerations.
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  Data: <searchLink fieldCode="AR" term="%22Loder%2C+Elizabeth+W%2E%22">Loder, Elizabeth W.</searchLink><br /><searchLink fieldCode="AR" term="%22Rizzoli%2C+Paul%22">Rizzoli, Paul</searchLink>
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  Data: <searchLink fieldCode="JN" term="%22Headache%3A+The+Journal+of+Head+%26+Face+Pain%22">Headache: The Journal of Head & Face Pain</searchLink>. Sep2011, Vol. 51 Issue 8, p1336-1345. 10p.
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  Data: <searchLink fieldCode="DE" term="%22Migraine+prevention%22">Migraine prevention</searchLink><br /><searchLink fieldCode="DE" term="%22Drug+tolerance%22">Drug tolerance</searchLink><br /><searchLink fieldCode="DE" term="%22Migraine%22">Migraine</searchLink><br /><searchLink fieldCode="DE" term="%22Research+funding%22">Research funding</searchLink><br /><searchLink fieldCode="DE" term="%22Disease+relapse%22">Disease relapse</searchLink><br /><searchLink fieldCode="DE" term="%22Disease+progression%22">Disease progression</searchLink>
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  Label: Abstract
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  Data: A familiar situation in migraine treatment is the patient with an initial positive response to prophylactic drug therapy who later experiences relapse. The goals of this paper are to provide a theoretical framework to help doctors think about this problem, to evaluate factors and response patterns that may be associated with different causes of relapse, and to suggest clinical strategies that may aid in its management. Six key explanations for loss of benefit from prophylactic therapy are: (1) pharmacokinetic, pharmacodynamic, and behavioral drug tolerance; (2) non-specific or placebo effects; (3) natural variability in disease activity; (4) disease progression; (5) inaccurate recall of treatment effects; and (6) drug delivery problems. Current options for patients who experience loss of benefit from prophylactic therapy include traditional techniques such as switching, re-trying, rotating, or combining drugs. Selected behavioral and environmental treatment techniques might also be useful. We describe a practical, structured approach to evaluation and management of relapse with migraine prophylaxis. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Headache: The Journal of Head & Face Pain is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1111/j.1526-4610.2011.01986.x
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      – Code: eng
        Text: English
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      – SubjectFull: Migraine prevention
        Type: general
      – SubjectFull: Drug tolerance
        Type: general
      – SubjectFull: Migraine
        Type: general
      – SubjectFull: Research funding
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      – SubjectFull: Disease relapse
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      – SubjectFull: Disease progression
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