Résumé :
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[BDSP. Notice produite par INIST 3eD7oR0x. Diffusion soumise à autorisation]. Context Various guidelines recommend different strategies for selecting and sequencing acute treatments for migraine. In step care, treatment is escalated after first-line medications fail. In stratified care, initial treatment is based on measurement of the severity of illness or other factors. These strategies for migraine have not been rigorously evaluated. Objective To compare the clinical benefits of 3 strategies : stratified care, step care within attacks, and step care across attacks, among patients with migraine. Design and Setting Randomized, controlled, parallel-group clinical trial conducted by the Disability in Strategies Study group from December 1997 to March 1999 in 88 clinical centers in 13 countries. Patients A total of 835 adult migraine patients with a Migraine Disability Assessment Scale (MIDAS) grade of II, III, or IV were analyzed as the efficacy population ; the safety analysis included 930 patients. Interventions Patients were randomly assigned to receive (1) stratified care (n=279), in which patients with MIDAS grade II treated up to 6 attacks with aspirin, 800 to 1000 mg, plus metoclopramide, 10 mg, and patients with MIDAS grade III and IV treated up to 6 attacks with zolmitriptan, 2.5 mg ; (2) step care across attacks (n=271), in which initial treatment was with aspirin, 800 to 1000 mg, plus metoclopramide, 10 mg. Patients not responding in at least 2 of the first 3 attacks switched to zolmitriptan, 2. (...)
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