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Groundbreaking Chronic Migraine Study Enrolling Now

MOTS200All of us who struggle with Migraine disease know that there's an enormous need for more research into Migraine. Yes, we need more research to find new and better treatments, but there are other types of research we need also. We need more research into the epidemiology and pathophysiology of Migraine, and we need research to answer specific questions about treating Migraine.

The good news is that there's a trial currently enrolling to answer one of the specific questions about treating Migraine. The trial is the Medication Overuse Treatment Strategy (MOTS) Trial. It's designed to answer questions that are very important to people with chronic Migraine. One of the biggest challenges to all of us with chronic Migraine is that using acute medications more than two or three days a week can very easily lead us to another problem, medication overuse headache (MOH).

Before I tell you more about this important study, let's discuss MOH a bit. First, I realize that the name "medication overuse headache" is a problem for some people. Let me assure you that it's just a name. Nobody associated with the study is passing judgement or blaming anyone who finds themselves in an MOH situation.

For anyone who isn't familiar with what MOH is or what can cause it, here's more info. The International Headache Society has set diagnostic and classification criteria for MOH that are quite complete in listing which medications can cause MOH in their International Classification of Headache Disorders, 3rd edition (ICHD-3). For a diagnosis of medication overuse headache, a pateint must experience at least 15 days of headache per month, and meet this criteria:

8.2 Medication-overuse headache (MOH)

8.2.1 Ergotamine-overuse headache Overuse defined as ergotamine intake on 10 or more days/month on a regular basis for more than 3 months.

8.2.2 Triptan-overuse headache
Overuse defined as triptan intake (any formulation) on 10 or more days/month on a regular basis for more than 3 months.

8.2.3 Analgesic-overuse headache
Overuse defined as intake of simple analgesics on 15 or more days/month on a regular basis for more than 3 months.

  • Paracetamol (acetaminophen)-overuse headache Regular intake of paracetamol on 15 days per month for more than 3 months.
  • Acetylsalicylic acid-overuse headache Regular intake of acetylsalicylic acid on 15 days per month for more than 3 months.
  • Other non-steroidal anti-inflammatory drug (NSAID)-overuse headache
    Regular intake of one or more NSAIDs other than acetylsalicylic acid on 15 days per month for more than 3 months.

8.2.4 Opioid-overuse headache Overuse defined as intake of opioids on 10 or more days/month on a regular basis for more than 3 months.** Comment:** Studies show that patients overusing opioids have the highest relapse rate after withdrawal treatment.

8.2.5 Combination analgesic-overuse headache Overuse defined as intake of simple analgesic medications on 10 or more days/month on a regular basis for more than 3 months.** Note:** The term combination-analgesic is used specifically for formulations combining drugs of two or more classes, each with analgesic effect or acting as adjuvants.

8.2.6 Medication-overuse headache attributed to multiple drug classes not individually overused
Regular intake of any combination of ergotamine, triptans, simple analgesics, NSAIDs and/or opioids on a total of 10 days per month for more than 3 months without overuse of any single drug or drug class alone.

As you can see, any acute medication (medication used to treat a Migraine or headache when it occurs) can, if overused, cause MOH. Even alternating the types of acute medications leaves us vulnerable to MOH (see 8.2.6 above). 

More about the study:

This video by Dr. David Dodick, one of the primary investigators of the MOTS trial is a good introduction to the study:

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:

  • Transition from the overused acute medication used during migraine attacks to different acute medication (prescribed with parameters to avoid medication overuse) with optimized preventive treatment;
  • Optimized preventive treatment without transition from the overused acute medication.

Although both of these treatment strategies are commonly used, there's insufficient evidence to know if one of these methods is superior to the other or if they provide similar outcomes. 

Patients participating in the study will be randomly assigned to one of two treatment arms matching the two strategies. It's very important to understand that patients who are randomized into the transition arm, will NOT be left without acute treatments. The treatments causing medication overuse will be discontinued, BUT other treatments will be prescribed to take their place.

There are no experimental treatments being used in this study. Participants must be patients at one of the study locations or become patients at one of them so they get consistent treatment from their own physician during the study. Centers participating in the study include Migraine and headache centers, general neurology practices, and family medicine practices. Centers participating in this study include:


  • Northern Arizona Healthcare Medical Group; Flagstaff, Arizona
  • Mayo Clinic in Arizona Headache Center; Phoenix, Arizona
  • Mayo Clinic in Arizona Neurology Center; Phoenix, Arizona
  • Pinnacle Internal Medicine and Headache Center; Phoenix, Arizona
  • Mayo Clinic Thunderbird; Scottsdale, Arizona


  • Orange County Migraine and Headache Center; Irvine, California
  • Cedars-Sinai Medical Center; Los Angeles, California


  • University of Colorado Denver Colorado Headache Center; Aurora, Colorado
  • University of Colorado Denver Primary Center; Denver, Colorado


  • Mayo Clinic Florida Headache Center; Jacksonville, Florida


  • Brigham Women's Hospital Headache Clinic; Boston, Massachusetts
  • Brigham Women's Hospital Neurology Clinic; Boston, Massachusetts


  • Mayo Clinic Headache Center; Rochester, Minnesota

New York

  • DENT Neurologic Institute Amherst, New York


  • University of Cincinnati Neurology; Cincinnati, Ohio
  • University of Cincinnati Primary; Cincinnati, Ohio
  • University of Cincinnati Headache Center; Dayton, Ohio
  • Toledo Clinic General Neurology; Toledo, Ohio


  • Thomas Jefferson University Hospital Headache Center; Philadelphia, Pennsylvania
  • Preferred Headache Center; Pittsburgh, Pennsylvania


  • University of Utah Primary Care; Salt Lake City, Utah
  • University of Utah General Neurology; Salt Lake City, Utah
  • University of Utah Headache Center; Salt Lake City, Utah


  • Medical College of Wisconsin; Milwaukee, Wisconsin

The primary investigators for the MOTS trial are Dr. Todd Schwedt and Dr. David Dodick, both at the Mayo Clinic Headache Center in Arizona. I'm honored to be their co-investigator for this trial, my first venture into research. The study is funded by the Patient Centered Outcomes Research Institute (PCORI).

If you have chronic Migraine and medication overuse, I hope you'll consider being part of this important study. It's an opportunity to address your Migraine treatment AND to help answer this important question that so many of us face.

For more information:

  • Visit the MOTS Trial web site.
  • Check out the MOTS Trial Facebook page.
  • Follow @MOTSTrial on Twitter.
  • Click the "Email Me" button to the right or at the bottom of this page, depending on how you're viewing this post, to send me an email.

Live well,

 because a migraine is NOT "just a headache"



 drawing on our inner Ninja to live a full life
Visit Migraine.Ninja

Sunday Thoughts on Living with Migraine: Say Migraine, Not Headache

TulipThoughtsGood afternoon and happy Sunday to my extended Migraine and Headache family!

We're always looking for ways to get people to understand Migraine disease and it's impact on us. Myths and misconceptions still abound AND continue to feed the social stigma associated with Migraine.

In the last few weeks, I've had occasion to speak with people who don't have Migraine themselves, but care about the Migraine patient population. In a meeting with about 40 people present, one asked me how we can combat the stigma. It was a moment during which I'd know that question was going to be asked so I'd have had an answer prepared. But I didn't have advance warning, so I shared the first thing that came to mind...

We can help reduce the stigma by removing the phrase, "Migraine headache" from our vocabulary.


Here's my reasoning:

  • One of the most prevalent and damaging misconceptions about a Migraine is that it's "just a headache." When a great many people hear the phrase, "Migraine headache," they don't truly hear the "Migraine" part. All they hear is, "headache," so they think of a "simple" headache that should respond to Tylenol, Advil, or some other over-the-counter remedy. They're drawing on their own experience, so they're thinking of the mild tension-type headache that about 85% of the population experiences at some time during their lives. 
  • Migraine attacks can and do occur with no headache. When that happens, they're described as "acephalgic" or "silent" Migraines
  • When headache does occur during a Migraine attack, it's only one symptom of the attack.
  • The symptom of headache alone is insufficient for a diagnosis of Migraine. There must be accompanying symptoms.

It's easy to forget how much power words can have, but once we think about it, we can begin to harness that power and use it to our advantage in awareness and advocacy efforts. 

I hope you'll join me in this simple effort that can have enormous impact. When talking about an individual Migraine episode, let's say "Migraine attack." When talking about the condition, let's say "Migraine disease" to help people realize that Migraine is indeed a genetic neurological disease. Once we do this for a while, it becomes habit, and we do it without even thinking about it.

Live well,

 because a migraine is NOT "just a headache"



 drawing on our inner Ninja to live a full life
Visit Migraine.Ninja

Sunday Thoughts on Living with Migraine: After Awareness Month

TulipThoughtsGood afternoon, and happy Sunday to my extended Migraine and Headache Family!

Migraine and Headache Awareness Month (MHAM) was in June, but the need to raise awareness never ends. Lack of awareness in the general public results in:

  • the perpetuation of myths and misconceptions about Migraine, Cluster Headaches, and other Headache disorders
  • the continuation of the social stigma associated with Headache disorders
  • discomfort and reduced quality of life for people who have Headache disorders

Advocacy-All-Year-300So it's important that we strive to raise awareness all the time, not just during Migraine and Headache Awareness Month.

Since you're reading this, it's a given that you spend some time online. Social media outlets such as Facebook and Twitter are magnificent ways to share information and raise awareness! They're easy to use, and quite a bit can be accomplished with minimal effort. That makes them great tools for those of us whose time and energy are limited by chronic Headache disorders.

One easy way to keep track of awareness and advocacy opportunities is to keep an eye on my Facebook page. I'm constantly posting links to educational articles about Migraine and other Headache disorders, Migraine and Headache treatments, and events such as Headache on the Hill and Migraine and Headache Awareness Month. Simply sharing these links on your Facebook page is a quick and simple way to help raise awareness.

If you're looking for the most recent information about Migraine and other Headache disorders and their treatments as well as support and advocacy and awareness info, check out our HealthCentral Migraine Management group on Facebook.

A don't-miss source of information and support is the American Migraine Foundation's Move Against Migraine campaign. You can check it out on the American Migraine Foundation web site or through the widget below.

There are many ways to raise awareness year-round. I've barely scratched the surface here. If you have ways to raise awareness that you'd like to share, please leave a comment, and tell us about them. 

Live well,

 because a migraine is NOT "just a headache"



 drawing on our inner Ninja to live a full life
Visit Migraine.Ninja