Psychiatry - October 2008 - (Page 20)

Trend Watch patients are treated by primary care physicians and an additional 21 percent are treated by neurologists. Psychiatrists play a small role in the treatment of migraine, and they treat only slightly more than one percent of migraine patients. 5HT-1 agonists represent 42 percent of migraine treatment. Pain products (both narcotic and non-narcotic) and antiepileptics account for an additional 21 percent and 13 percent of migraine therapy treatments, respectively. Psychiatric medications, such as tricyclic antidepressants, are not commonly used in the treatment of migraine (3.5% of medication uses). A discussion of data is provided. KEY WORDS: migraine, psychiatry, comorbidity, pharmacotherapy INTRODUCTION It has long been recognized that tricyclic antidepressants (TCAs) are widely used off label for a variety of conditions, including migraine. In this Trend Watch, we examine the treatment of migraine and the role of psychiatric medications. METHODS Treatment of Migraine and the Role of Psychiatric Medications by Elisa Cascade; Amir H. Kalali, MD; and Todd A. Smitherman, PhD Psychiatry (Edgemont) 2008;5(10):20–22 We obtained data from SDI Health’s Prescription Drug and Diagnosis Audit (PDDA) regarding products used to treat migraine (ICD-9 diagnosis code 346) over the year from August 2007 through July 2008. RESULTS Over the past year, there were approximately 5.5 million patients treated for migraine. Approximately 50 percent of migraine patients are treated by primary care physicians (family practice, general practice, internal medicine) (Figure 1). An additional 21 percent of patients are treated by neurologists. Psychiatrists play a small role in the treatment of migraine because they treat only slightly more than one percent of migraine patients. Figure 2 displays classes of medication used in the treatment of 20 AUTHOR AFFILIATIONS: Ms. Cascade is Vice President, Quintiles Inc./iGuard, Falls Church, Virginia; and Dr. Kalali is Vice President, Global Therapeutic Group Leader CNS, Quintiles Inc., San Diego, California, and Professor of Psychiatry, University of California, San Diego; and Dr. Smitherman is Assistant Professor, Department of Psychology, University of Mississippi, Oxford, Mississippi. ADDRESS CORRESPONDENCE TO: Ms. Elisa Cascade, Vice President, Quintiles, Inc./iGuard, 3130 Fairview Park Drive, Suite 501, Falls Church, VA 22042; E-mail: elisa.cascade@quintiles.com ABSTRACT: Over the past year, there were approximately 5.5 million patients treated for migraine. Approximately 50 percent of migraine 20 Psychiatry 2008 [ O C T O B E R ]

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Psychiatry - October 2008 Editor’s Message Editorial Advisory Board Contents Psych Rx Treatment of Migraine and the Role of Psychiatric Medications Play Therapy: A Case-based Example of a Nondirective Approach Delirium and Antipsychotics: A Systematic Review of Epidemiologyand Somatic Treatment Options Severely Mood-disordered Youth Respond Less Well to Treatment in a Community Clinic than Youth with Bipolar Disorder Beyond Informed Consent: The Ethics of Informing, Anticipating, and Warning Asthma: Wheezing, Woes, and Worries Classified Advertising Journal Watch Information for Authors

Psychiatry - October 2008

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