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Randomised controlled trial
Combined prophylactic β-blocker and behavioural migraine management improves 30-day migraine outcomes compared with either strategy alone, or optimised acute treatment only
  1. Richard B Lipton
  1. Albert Einstein College of Medicine, New York, USA
  1. Correspondence to Richard B Lipton
    1165 Morris Park Ave/Bronx, NY 10461, USA; Richard.lipton{at}

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Migraine is a common and temporarily disabling neurologic disorder affecting about 11% of the general population in western countries, including the UK and the USA.1 Optimal migraine treatment involves both behavioural interventions and pharmacotherapy.2


Holroyd and colleagues present a four-arm randomised placebo controlled trial in two study centres comparing the separate and joint effects of preventive pharmacotherapy and behavioural intervention in migraine sufferers, following optimisation of acute treatment.

Eligible patients were 18 to 65 years of age who met the criteria of the International Classification of Headache Disorders for migraine without aura or migraine with aura. Patients were recruited by both physician referral and advertisements and had to have at least 3 migraine days with disability per month and no more than 20 headache days per month. Acute migraine treatment was optimised prior to randomisation.

The patients were randomised to one of the four treatment arms: (1) β-blocker alone (β-blocker monotherapy); (2) β-blocker placebo and a behavioural …

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  • Competing interests RBL has received research grants, lecture honoraria or consulting fees from several manufacturers of migraine medications such as Allergan, Inc, Bristol Meyers Squibb, Johnson and Johnson, the National Institutes of Health, the National Headache Foundation, Glaxo SmilthKline, Pfizer, Inc, Merck, MAP, Nautilus Neurosciences and Novartis.