Novel Approaches in Migraine Therapy: Diagnosis and Treatment of Acute and Chronic Migraine

Title:	Novel Approaches in Migraine Therapy: Diagnosis and Treatment of Acute and Chronic Migraine
Topic:	Neurology
Relevant Terms:	Acute Migraine, Chronic Migraine
Primary Audience:	Neurologists, Primary Care Nurse Practitioners, Primary Care Physician Assistants, Primary Care Physicians
Launch Date:	02-Nov-12
Credits:	1 AMA PRA Category 1 Credit™
Expiration Date:	02-Nov-13
Curriculum Name:	Novel Approaches to Migraine Therapy

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Learning Objectives

After completing this activity, the participant will demonstrate the ability to:

Identify potential barriers to the recognition and diagnosis of migraine
Differentiate between episodic and chronic migraine
Identify candidates for acute and preventive migraine therapy
Discuss the importance of the administration of acute migraine medication
Develop a treatment plan for patients who are eligible for acute and preventive therapy

Faculty

Sheena K. Aurora, MD–Course Leader
Clinical Associate Professor
Department of Neurology
Stanford University
Stanford, California

David W. Dodick, MD
Professor of Neurology
Mayo Clinic
Phoenix, Arizona

David W. Dodick, MD

David W. Dodick received his medical degree with distinction from Dalhousie University in Halifax, Nova Scotia, Canada. His postdoctoral training included an internship and neurology residency at the Mayo Clinic in Rochester, Minnesota and fellowships in headache medicine at the University of Toronto in Ontario, Canada. Dr. Dodick is Program Director of the Mayo Clinic Neurology Residency Program and Mayo Clinic Headache Fellowship Program in Scottsdale Arizona.

Board certified by the Royal College of Physicians and Surgeons of Canada and the American Board of Psychiatry and Neurology, Dr. Dodick also holds certification in headache medicine from the United Council for Neurologic Subspecialties and in vascular neurology from the American Board of Psychiatry and Neurology certification. Additionally, Dr. Dodick holds positions of prominence with several professional organizations. He is Immediate Past-President of the American Headache Society (AHS), Chair of the International Headache Congress (IHC) Scientific Program Committee 2009, the Appointed Chair of the American Migraine Foundation, Vice-Chair of the World Federation of Neurology headache research group, and a member of the Scientific Committee of the Migraine Trust/European Headache Federation and the World Congress of Controversies in Neurology. Among Dr. Dodick's many honors, in 2012 he received the Dalhousie University Alumnus of the Year Award, the AHS John Graham Distinguished Clinician Award, the Arizona Medical Association Sportsman of the Year Award for public health work on concussion prevention in youth sports, and the American Pain Society Global Year Against Headache Special Lecturer award.

Dr. Dodick has published more than 250 articles in the peer-reviewed literature and has co-authored seven books. He is editor-in-chief of Cephalalgia and a member of the editorial boards of several journals, including Lancet Neurology and The Neurologist. He is also a major contributor to clinical trial guidelines, clinical trial design, and substantive original and review publications in the field of headache medicine.

Susan L. Hutchinson, MD
Associate Clinical Professor
Department of Family Medicine
University of California-Irvine Medical Center
Director and Founder
Orange County Migraine & Headache Center
Irvine, California
Director, Hoag Headache and Facial Pain Program
Newport Beach, California

Novel Approaches in Migraine Therapy: Diagnosis and Treatment of Acute and Chronic Migraine

Release date: November 2, 2012

Expiration date: November 2, 2013

Estimated time to complete activity: 1 hour

Co-sponsored by Penn State College of Medicine and Curatio CME Institute

Support for this activity has been provided through an educational grant from Allergan and MAP Pharmaceuticals.

Activity Overview

Migraine is a medical condition that affects 12% of the general population of the United States and is one of the most disabling disorders worldwide. Women experience migraines three times more frequently than men, and the age group most commonly affected is adults between the ages of 30 and 40 years. Despite the common occurrence of migraine, many with this condition go undiagnosed. Among those who do receive a diagnosis, the treatment they receive is frequently inappropriate and ineffective. This activity uses a linear, case-based format to address common challenges in the diagnosis and management of both episodic and chronic migraine.

Target Audience

This activity has been designed to meet the educational needs of neurologists, primary care physicians, primary care nurse practitioners, primary care physician assistants, and other health care providers involved in the diagnosis and management of patients with chronic or acute migraine.

Accreditation Statement

Penn State College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. This activity is co-sponsored by Curatio CME Institute, an ACCME-accredited provider.

Credit Designation

Penn State College of Medicine designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Method of Participation

There are no fees for participating in this CME activity. To receive credit during the period November 2, 2012 to November 2, 2013, participants must (1) read the learning objectives and disclosure statements, (2) study the educational activity, and (3) complete the posttest and activity evaluation.

To obtain a certificate, participants must receive a score of 70% or better on the posttest. The posttest can be accessed at the end of the activity. Please e-mail any questions to cmeinfo@curatiocme.com.

For questions about CME credit for this activity, contact Penn State at ContinuingEd@hmc.psu.edu or (717) 531-6483. Reference course #G5155-13-S.

Medium

The Internet was selected as the instructional format to accommodate the learning preferences of a significant portion of the target audience.

Disclosure

In accordance with the ACCME Standards for Commercial Support, all CME providers are required to disclose to the activity audience the relevant financial relationships of everyone in a position to control content of an educational activity. A relevant financial relationship is a relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the CME activity content over which the individual has control. Relationship information appears below:

Sheena K. Aurora, MD, has disclosed the following relevant financial relationships:

Consultant/Speaker	Allergan, MAP Pharmaceuticals, Merck
Research	Eli Lilly & Company

Dr. Aurora discusses the unlabeled or investigational use of a commercial product.

David W. Dodick, MD, has disclosed the following relevant financial relationships:

Consultant	Alder, Allergan, Arteaus, Autonomic Technologies, Boston Scientific, Bristol Myers Squibb, Coherex, Colucid, Eli Lilly & Company, Ferring, GlaxoSmithKline, Impax Laboratories, MAP Pharmaceuticals, Medtronic, Merck, Nautilus, Neuralieve, Neuraxon, Neurocore, Nevro Corporation, Novartis, NuPathe, Pfizer, SmithKline Beecham, Zogenix
Grant support	ANS, Medtronic, St. Jude

Dr. Dodick discusses the unlabeled or investigational use of a commercial product.

Susan L. Hutchinson, MD, has disclosed the following relevant financial relationships:

Consultant	Allergan, Forest Laboratories, GlaxoSmithKline, MAP Pharmaceuticals, NuPathe, Zogenix
Speaker	Forest Laboratories, GlaxoSmithKline, Zogenix

Dr. Hutchinson discusses the unlabeled or investigational use of a commercial product.

Curatio CME Institute

Thomas Finnegan, PhD, Associate Medical Director, Curatio CME Institute, has disclosed no relevant financial relationships.

Jonathan S. Simmons, ELS, Senior Managing Editor, has disclosed no relevant financial relationships.

Penn State College of Medicine

Penn State staff involved in the development and review of this activity have disclosed no relevant financial relationships.

Disclaimer

The information presented at this activity is for continuing medical education purposes only and is not meant to substitute for the independent medical judgment of a physician regarding diagnosis and treatment of a specific patient's medical condition.

Unapproved Product Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration. Curatio CME Institute, Penn State College of Medicine, Allergan, and MAP Pharmaceuticals do not recommend the use of any agent outside the labeled indications.

The opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of Curatio CME Institute, Penn State College of Medicine, Allergan, or MAP Pharmaceuticals. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Generic Name	Trade Name	Approved Use (if any)	Unapproved/ Investigational Use
Amitriptyline	Elavil	For the relief of the symptoms of depression	Acute migraine therapy; chronic migraine therapy
Atenolol	Tenormin	Management of hypertension; the long-term management of angina pectoris; the management of hemodynamically stable patient with definite or suspected myocardial infarction	Acute migraine therapy
Divalproex sodium	Depakote	Monotherapy and adjunctive therapy of complex partial seizures and simple and complex absence seizures; adjunctive therapy in patients with multiple seizure types that include absence seizures	Acute migraine therapy; chronic migraine therapy
Duloxetine	Cymbalta	Major depressive disorder; generalized anxiety disorder; diabetic peripheral neuropathic pain; fibromyalgia; chronic musculoskeletal pain	Chronic migraine preventive therapy
Metoprolol	Lopressor	Hypertension; long-term treatment of angina pectoris; treatment of hemodynamically stable patient with definite or suspected myocardial infarction	Acute migraine therapy
Sodium valproate	Depakene	Monotherapy and adjunctive therapy in the treatment of patients with complex partial seizures that occur either in isolation or in association with other types of seizures; use as sole and adjunctive therapy in the treatment of simple and complex absence seizures, and adjunctively in patients with multiple seizure types which include absence seizures.	Acute migraine therapy
Timolol	Blocadren	Treatment of hypertension; in patients who have survived the acute phase of myocardial infarction, and are clinically stable, to reduce cardiovascular mortality and the risk of reinfarction.	Acute migraine therapy
Topirimate	Topamax	Initial monotherapy in patients ≥ 2 years of age with partial onset or primary generalized tonic-clonic seizures; adjunctive therapy for adults and pediatric patients (2 to 16 years of age) with partial onset seizures or primary generalized tonic-clonic seizures, and in patients ≥2 years of age with seizures associated with Lennox-Gastaut syndrome; treatment for adults for prophylaxis of migraine headache	Acute migraine therapy
Venlafaxine	Effexor	Treatment of major depressive disorder; treatment of generalized anxiety disorder as defined in DSM-IV; treatment of social anxiety disorder, also known as social phobia, as defined in DSM-IV (300.23); treatment of panic disorder, with or without agoraphobia, as defined in DSM-IV.	Acute migraine therapy; prevention of chronic migraine

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