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To the Editor: Dr Lipton and colleagues¹ compared "stratified care" with 2 different "step-care" strategies for the treatment of migraine headache. In stratified care, the choice of migraine treatment is based on time lost due to headaches during the previous 3 months. Step-care treatment starts with relatively simple medication (eg, aspirin plus metoclopramide) and is escalated to more specific medication (eg, zolmitriptan) when headache response is unsatisfactory.

Lipton et al found that headache response at 2 hours was significantly better in the stratified-care treatment group (52.7%) than in either the step-care-across-attacks (40.6%) or the step-care-within-attacks group (36.4%). In addition, disability time was significantly less in the stratified-care group. They concluded that stratified care provides better clinical outcomes than step-care strategies.¹

A drawback of stratified care is that some patients are treated with specific antimigraine medication, such as a triptan, when simple analgesics might have been sufficient. Unless adverse effects appeared, . . . [Full Text of this Article]

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