Patients begin treatment at the bottom of a therapeutic ladder, with therapy being escalated until an effective treatment is found. Physicians may initiate treatment with agents such as simple analgesics for a series of migrane attacks, and if the initial therapy is not sufficient, a second-line treatment such as combination analgesics is administered. If this fails, treatment is escalated to migraine-specific medications such as triptans.
A step-care-across-attacks strategy potentially involves patients ‘stepping through’ several therapies before finding one that is effective, which may result in wasted time and costs due to multiple physician visits. During this time, patients continue to experience the pain, anxiety and inconvenience of migraine and may ultimately lapse from care before an effective therapy is prescribed.
In summary, with a step-care-across-attacks approach, many patients are denied the opportunity to benefit from treatment at an early stage.
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