The 'Act when Mild' (AwM) study: a step forward in our understanding of early treatment in acute migraine

Cephalalgia : an International Journal of Headache
Peter J Goadsby

Abstract

An important issue in the management of migraine is the advice given to patients as to when to take their treatment in the course of the attack. While it seems common sense almost to take treatment early in the attack, the evidence base for that advice is not as robust as could be expected. The 'Act when Mild' (AwM) Study was a randomized, four-arm, multicentre, multinational, double-blind, placebo-controlled trial of almotriptan (12.5 mg) to compare outcomes after administration of treatment when pain intensity was mild and within 1 h of headache onset (mild/early) with outcomes when pain had become moderate or severe. Of 491 migraineurs enrolled, 403 were evaluable with an intention-to-treat population (ITT) of 404. At the primary end-point, 2 h pain free, on the ITT analysis 49% of patients in the almotriptan 12.5 mg treat early/mild group and 40% in the treat moderate/severe group had responded (P = 0.21). Of these patients, 43 did not take medication according to their randomly allocated baseline pain intensity (mild or moderate/severe) and were subsequently reassigned, prior to study unblinding, to the appropriate group (AwM population) for re-analysis of the primary outcome measure: 2-h pain-free rates. In the almotripta...Continue Reading

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Citations

Sep 6, 2008·Cephalalgia : an International Journal of Headache·D W Dodick
Jul 1, 2012·Pain Management·Mari Bozoghlanian, Sridhar V Vasudevan
Oct 15, 2010·Expert Review of Neurotherapeutics·Julio PascualCaroline C McGown
Jan 13, 2011·Current Medical Research and Opinion·Samuel Díaz-InsaCaroline C McGown
May 18, 2012·The Journal of Headache and Pain·Paola SarchielliGiorgio Zanchin
Apr 1, 2012·The Neurohospitalist·Amy A Gelfand, Peter J Goadsby
Feb 1, 2012·Cephalalgia : an International Journal of Headache·Jeong Wook ParkGo Eun Park
Jun 26, 2015·European Journal of Ophthalmology·Calin Petru TataruConstantin Mihai
Jun 10, 2011·The Neuroscientist : a Review Journal Bringing Neurobiology, Neurology and Psychiatry·Andrea CariaNiels Birbaumer
Aug 4, 2018·Continuum : Lifelong Learning in Neurology·Nazia KarsanPeter J Goadsby
Feb 5, 2019·Expert Opinion on Drug Metabolism & Toxicology·Chiara LupiAndrea Negro
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Apr 1, 2021·Current Medical Research and Opinion·Mario F P PeresDeborah I Friedman

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