Selecting Evidence-Based Pharmacologic Therapy and Designing Multimodal Treatment Plans for Migraine and Headache

Optimizing Differential Diagnosis and Treatment Strategies for Headaches and Migraines
1 AMA PRA Category 1 Credit(s)
Launch Date:
December 10, 2015
Expiration Date:
The accreditation for this activity has expired.

Primary Audience:

Physicians, Nurse practitioners, Physician assistants

Relevant Terms:

Chronic Migraine

Stephen D. Silberstein, MD

Stephen D. Silberstein, MD, Chair
Director, Jefferson Headache Center
Department of Neurology
Jefferson Hospital for Neuroscience
Philadelphia, PA

Stephen D. Silberstein, MD, is Professor of Neurology and Director of the Jefferson Headache Center at Thomas Jefferson University. He is a Fellow of the American College of Physicians, the American Academy of Neurology, and the American Headache Society. He has served the American Headache Society as President, Treasurer, and Board of Directors member. He has served on the Publications, Scientific, and Education Committees of the American Headache Society and was Co-chairman of the Annual Scientific Meeting. 
Dr. Silberstein received his medical degree from the University of Pennsylvania. After completing a fellowship in neurology at the National Hospital for Nervous Diseases in London, Dr. Silberstein served as a Pharmacology Research Associate in the Toxicology Laboratory of Clinical Science at the National Institutes of Mental Health, and completed a neurology residency at the Hospital of the University of Pennsylvania.

David W. Dodick, MD

David W. Dodick, MD
Director, Headache Division
Director, Sport Neurology and Concussion Program
Department of Neurology
Mayo Clinic
Phoenix, AZ

David W. Dodick, MD, FRCP (C), FACP, is Professor of Neurology at the Mayo Clinic College of Medicine and a consultant in neurology at the Mayo Clinic, in Scottsdale, Arizona. He is the Program Director of the Mayo Clinic Neurology Residency Program and Headache Medicine Fellowship Program. He is the Medical Director of the Headache Program as well as the Concussion Program at the Mayo Clinic in Arizona. 

Dr. Dodick received a medical degree with distinction from Dalhousie University, in Halifax, Nova Scotia. He completed an internship and a neurology residency at the Mayo Clinic, in Rochester, Minnesota, followed by fellowship training at the University of Toronto, in Ontario. Dr. Dodick is board certified by the Royal College of Physicians and Surgeons of Canada and the American Board of Psychiatry and Neurology (ABPN). He also holds United Council for Neurologic Subspecialties certification in headache medicine and ABPN certification in vascular neurology.

Dr. Dodick has authored more than 280 peer-reviewed publications and coauthored 8 books. He serves as Editor in Chief of Cephalalgia and is on the editorial board of several journals, including The Neurologist, Postgraduate Medicine, and Lancet Neurology. He is the Immediate Past-President of the American Headache Society, Chair of the American Migraine Foundation, and Vice-Chair of the World Federation of Neurology Headache Research Group.
1. Tailor abortive and prophylactic treatment for headache and migraine to the patient's symptom profile, prior response to medications, medical comorbidities and treatment preference
2. Utilize multimodal treatment approaches to improve outcomes of patients with headaches and migraines

Statement of Need
According to the 2010 Global Burden of Disease Study, headache represents one of the top 10 causes of disability, and migraine, in particular, is responsible for 3% of disability attributable to a specific disease. Although most headache patients are managed in the primary care setting, chronic headache remains the most common cause of neurological consultation. In the United States, the American Migraine Prevalence and Prevention (AMPP) study reported an overall prevalence of migraine headache of 11.7%, probable migraine of 4.5%, and chronic migraine (CM) of 1%. CM represents a more disabling and difficult-to-treat disorder than episodic migraine (EM). It is also the most common form of chronic daily headache seen in  US clinics. However, CM is an underdiagnosed and undertreated disorder; only 20%-25% of patients who meet the criteria for CM receive appropriate diagnosis today.
CM can be considered a complication of EM with more frequent attacks and fewer pain-free intervals. The AMPP study found that compared with EM patients, CM patients have doubly higher rates of depression, anxiety and chronic pain. Other disorders that are often seen in CM patients include respiratory disorders, cardiac risk factors, diabetes, and obesity. Notably, as demonstrated by recent studies, appropriate preventive treatment for CM might lessen headache disability, associated comorbidities, and improve health-related quality of life. Since an increasing number of CM patients present to neurology and pain specialists, it is of key importance that these health care providers are kept up-to-date with evidence-based best practices in establishing correct diagnosis for CM and choosing appropriate multimodal treatment strategies.

Physician Accreditation Statement
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Global Education Group (Global) and HealthmattersCME. Global is accredited by the ACCME to provide continuing medical education (CME) for physicians.

Physician Credit Designation
Global Education Group designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Contact Information
For information about the accreditation of this program, please contact Global at 303-395-1782 or

Fee Information and Refund/Cancellation Policy
There is no fee for this educational activity.

Disclosure of Conflicts of Interest
Global Education Group (Global) requires instructors, planners, managers, and other individuals and their spouse/life partner who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COIs are thoroughly vetted by Global for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient-care recommendations.
The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME/CE activity:

Name of Faculty or Presenter Reported Financial Relationship
Stephen D. Silberstein, MD, Chair Nothing to disclose
David W. Dodick, MD Consultant/Independent Contractor: Alcobra; Alder; Allergan; Amgen; Arteaus; Autonomic Technologies; Boston Scientific; Bristol-Myers Squibb; Colucid; Electrocore; Eli Lilly & Company; ENeura; Ethicon J&J;  Impax; Labrys; Lundbeck; MAP Pharmaceuticals; Medtronic; Merck; Novartis;  NuPathe;  Pfizer; St Jude;  Supernus;  Teva; Tonix; Zogenix

Alcobra; Alder; Allergan; Amgen; Arteaus; Autonomic Technologies; Boston Scientific; Bristol-Myers Squibb; Colucid; Electrocore; Eli Lilly & Company; ENeura; Ethicon J&J; Impax; Labrys; Lundbeck; MAP Pharmaceuticals; Medtronic; Merck; Novartis; NuPathe; Pfizer; St Jude; Supernus; Teva; Tonix; Zogenix
Allergan; American Academy of Neurology; Decision Resources; Healthlogix; IntraMed; John Wiley & Sons, Inc; Oxford University Press; SAGE Publishing; Starr Clinical; Sun Pharmaceuticals;  Synergy; Universal Meeting Management; UptoDate;  WebMD

The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME/CE activity:
Name of Planner or Manager Reported Financial Relationship
Andrea Funk Nothing to disclose
Amanda Glazar, PhD Nothing to disclose
James Murphy Nothing to disclose

Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Global Education Group (Global) and HealthmattersCME do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.

Instructions for Receiving Credit
In order to receive credit for this activity, the participant must review the content, complete the post-test with a passing score of 70% or higher, and complete the evaluation form.

This activity is jointly provided by Global Education Group and HealthmattersCME.
This activity is supported by an independent educational grant from Allergan.

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