CClinicalTrials.gg
CompletedNCT02764320MOTSUpdated Nov 12, 2021Results posted

The MOTS (Medication Overuse Treatment Strategy) Trial

An interventional study of Migraine Prophylactic Therapy Only and Discontinuation of Overused Medication in Migraine, sponsored by Mayo Clinic. Completed at 29 sites in United States. Open to participants aged 21 Years and older. Per ClinicalTrials.gov, last updated 2021-11-12.

Sponsored by Mayo Clinic · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
720
Allocation
Randomized
Ages
21 Years and older
Sex
All
01

Study summary

There are two commonly used treatment strategies for treating patients who have chronic migraine with medication overuse. This study will compare the outcomes amongst patients randomized to one of the two treatment strategies.

02

Conditions studied

03

Who can participate

Ages eligible
21 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Adults, at least 21 years of age
  • Chronic Migraine - diagnosed according to ICHD3beta criteria
  • Medication Overuse - diagnosed according to ICHD3beta criteria
  • Willingness to be randomized to either of the two treatment arms
  • Willingness to maintain a headache diary
  • Plan for follow-up care with the clinician
  • No changes to migraine prophylactic therapy within the 4 weeks prior to randomization.

Exclusion criteria

Exclusion Criteria

  • Younger than 21 years of age
  • Headache diagnoses other than chronic migraine with medication overuse; episodic tension-type headache on 3 or fewer days per month is allowed
  • Not willing to be randomized to either of the treatment arms
  • Not willing to maintain a daily headache diary
  • Not planning on follow-up care with the clinician
  • In the opinion of the clinician, randomization to either treatment arm would be considered unsafe (ex: pregnancy, immediate discontinuation
  • Prisoners
  • Diminished decision-making capacity which in the investigator's opinion would interfere with the person's ability to provide informed consent and complete study procedures.
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
720 participants (actual)

Study arms

  • Active comparator
    Discontinuation

    Migraine prophylactic therapy will be initiated or optimized with the immediate discontinuation of the overused medication(s)

    Other: Discontinuation of Overused Medication

  • Active comparator
    Preventive Therapy Only

    Migraine prophylactic therapy will be initiated or optimized without the early discontinuation of the overused medication(s)

    Other: Migraine Prophylactic Therapy Only

Interventions

  • OtherMigraine Prophylactic Therapy Only

    Start of new migraine preventive therapy or adjustment of current preventive therapy without immediate discontinuation of the overused medication(s)

  • OtherDiscontinuation of Overused Medication

    Immediate discontinuation of the overused medication(s) and the start of new migraine preventive therapy or adjustment of current preventive therapy

05

What researchers measure

Primary outcomes

  1. Frequency of Moderate to Severe Headache Days

    Number of days on which a headache lasts for at least 2 hours and at any time peaks at moderate or severe intensity

    Time frame: 12 weeks

06

Results

Posted Nov 12, 2021

Participant flow

Participant flow — Overall Study
MilestoneDiscontinuationPreventive Therapy Only
Started361359
Completed310310
Not completed5149
Withdrew: Withdrawal by subject3538
Withdrew: Protocol violation116
Withdrew: Adverse event20
Withdrew: Health issues unable to continue20
Withdrew: Did not meet inclusion criteria10
Withdrew: Subject moved02
Withdrew: Overused medication unavailable01
Withdrew: Seeking care outside site01
Withdrew: Technology barriers01

Outcome measures

PrimaryFrequency of Moderate to Severe Headache Days

Number of days on which a headache lasts for at least 2 hours and at any time peaks at moderate or severe intensity

Time frame:
12 weeks
Reported as:
Mean · days
Frequency of Moderate to Severe Headache Days
daysDiscontinuationPreventive Therapy Only
Frequency of Moderate to Severe Headache Days9.3 ± 7.29.1 ± 6.8

Adverse events

Collected over Adverse events were collected from baseline to end of study for a total of approximately 48 weeks on all participants.. Non-serious events are listed at a 1% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Discontinuation0/361 (0%)7/361 (1.9%)20/361 (5.5%)
Preventive Therapy Only1/359 (0.3%)7/359 (1.9%)16/359 (4.5%)
Most frequent serious events
Showing 10 of 19
Most frequent serious events
EventDiscontinuationPreventive Therapy Only
FractureMusculoskeletal and connective tissue disorders0/3612/359
AnemiaBlood and lymphatic system disorders0/3611/359
AnxietyPsychiatric disorders0/3611/359
DyspneaRespiratory, thoracic and mediastinal disorders0/3611/359
FatigueGeneral disorders0/3611/359
Joint Range of Motion Decrease Cervical SpineMusculoskeletal and connective tissue disorders0/3611/359
Non-Cardiac Chest PainGeneral disorders0/3611/359
PalpitationsCardiac disorders0/3611/359
PneumonitisRespiratory, thoracic and mediastinal disorders0/3611/359
SepsisInfections and infestations0/3611/359
Most frequent other events
Most frequent other events
EventDiscontinuationPreventive Therapy Only
ParesthesiaNervous system disorders7/3614/359
Weight GainInvestigations1/3616/359
Headache WorsenedNervous system disorders6/3615/359
FatigueGeneral disorders4/3612/359
SinusitisInfections and infestations4/3610/359

Baseline characteristics

Age, Continuous
Age, Continuous(years)DiscontinuationPreventive Therapy OnlyTotal
Mean45 ± 1344 ± 1344 ± 13
Sex: Female, Male
Sex: Female, Male(Participants)DiscontinuationPreventive Therapy OnlyTotal
Female313317630
Male484290
Race/Ethnicity, Customized
Race/Ethnicity, Customized(Participants)DiscontinuationPreventive Therapy OnlyTotal
White Non-Hispanic270273543
Other9186177
Region of Enrollment
Region of Enrollment(participants)DiscontinuationPreventive Therapy OnlyTotal
United States361359720
07

Study locations

29 sites
  • Northern Arizona Healthcare Medical Group
    Flagstaff, Arizona 86001, United States
  • Mayo Clinic in Arizona Headache Center
    Phoenix, Arizona 85054, United States
  • Mayo Clinic in Arizona Neurology Center
    Phoenix, Arizona 85054, United States
  • Honor Health Neurology
    Scottsdale, Arizona 85251, United States
  • Mayo Clinic Thunderbird
    Scottsdale, Arizona 85260, United States
  • Keck Medical Center of USC
    Los Angeles, California 90033, United States
  • University of Colorado Denver Headache Center
    Aurora, Colorado 80045, United States
  • University of Colorado Denver Primary Center
    Denver, Colorado 80238, United States
  • Blue Sky Neurology
    Greenwood Village, Colorado 80111, United States
  • Memorial Healthcare
    Hollywood, Florida 33021, United States
  • University of Miami Miller School of Medicine
    Miami, Florida 33136, United States
  • Norton Neurology
    Louisville, Kentucky 40207, United States
  • Brigham Women's Hospital Headache Clinic
    Boston, Massachusetts 02130, United States
  • Brigham Women's Hospital Neurology Clinic
    Boston, Massachusetts 02130, United States
  • Henry Ford Allegiance Health
    Jackson, Michigan 49201, United States
  • Mayo Clinic Headache Center
    Rochester, Minnesota 55905, United States
  • The Headache Center
    Ridgeland, Mississippi 39157, United States
  • Clinvest Research
    Springfield, Missouri 65801, United States
  • University of Cincinnati Neurology
    Cincinnati, Ohio 45417, United States
  • Cleveland Clinic
    Cleveland, Ohio 44195, United States
  • University of Cincinnati Headache Center
    Dayton, Ohio 45417, United States
  • Toledo Clinic Adult Neurology
    Toledo, Ohio 43623, United States
  • Thomas Jefferson University Hospital Headache Center
    Philadelphia, Pennsylvania 19107, United States
  • Preferred Headache Center
    Pittsburgh, Pennsylvania 15236, United States
  • University of Utah Primary Care
    Salt Lake City, Utah 84106, United States
  • University of Utah General Neurology
    Salt Lake City, Utah 84108, United States
  • University of Utah Headache Center
    Salt Lake City, Utah 84132, United States
  • University of Washington
    Seattle, Washington 98195, United States
  • West Virginia University Neurology
    Morgantown, West Virginia 26506, United States
08

References and documents

Publications

  • Schwedt TJ, Hentz JG, Sahai-Srivastava S, Murinova N, Spare NM, Treppendahl C, Martin VT, Birlea M, Digre K, Watson D, Leonard M, Robert T, Dodick DW; MOTS Investigators. Patient-Centered Treatment of Chronic Migraine With Medication Overuse: A Prospective, Randomized, Pragmatic Clinical Trial. Neurology. 2022 Apr 5;98(14):e1409-e1421. doi: 10.1212/WNL.0000000000200117. Epub 2022 Feb 15. PubMed 35169011 ↗

Study documents

  • Protocol and statistical analysis plan · Aug 1, 2020

Documents are hosted by the registry — open the source record to download them.

09

Registry details

Key details

Study ID
NCT02764320
Lead sponsor
Mayo Clinic
Collaborators
Patient-Centered Outcomes Research Institute
Responsible party
Todd J. Schwedt (PI, Mayo Clinic) — Principal investigator
First posted
May 6, 2016
Start date
Jan 9, 2017
Primary completion
Mar 31, 2021
Completion
Mar 31, 2021
Results posted
Nov 12, 2021
Last update
Nov 12, 2021

Study contacts

Todd J Schwedt, MD
principal investigator · Mayo Clinic
David W Dodick, MD
principal investigator · Mayo Clinic

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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