Migraine clinical trials: Interview with Dr Emmanouil Dermitzakis
Balancing clinical research and clinical practice can be challenging, but also immensely rewarding. Recently, Dr Emmanouil Dermitzakis took time out of his busy schedule to sit down with the Neurologybytes team and discuss his work as a headache specialist in the medical general clinic of Thessaloniki in Greece, focusing on his belief that clinical studies will lead to improvements in the treatment of the patients he sees regularly.
"Clinical studies are the weapon we have to add practical knowledge to medical science.”
Investigators face many challenges when designing and conducting clinical trials for new migraine therapies. These range from gaining a full understanding of a study’s objectives, to the day‑to‑day practicalities of running a large study that involves teams of medical and nursing staff. However, Dr Dermitzakis believes that the challenges of conducting clinical trials are outweighed by the opportunity to improve scientific knowledge of migraine, and ultimately to improve the standard of care for patients.
“We place great importance on the preparation of the study.”
For Dr Dermitzakis, communication between medical staff and a prospective study participant is vital. Alongside ascertaining whether a patient meets all inclusion criteria for a study, it is also important to understand how participation in a study will affect a patient. For some patients, study participation may increase expectations of an improvement in migraine. For others, study participation may trigger anxiety. These issues need to be considered by a clinician when deciding whether a patient is suitable for a clinical trial.
Once a patient is enrolled in a clinical trial, it is important for the study investigator to maintain contact with them and remain available to answer any questions about the study. This often involves being proactive in confirming that headache diaries are completed correctly, and checking that hospital visits occur within the parameters outlined in the study protocol. A well understood study and participant group can contribute to ensuring that the evidence generated during clinical research is as robust as possible.
“The challenges are many.”
Dr Dermitzakis has a keen interest in the diagnosis and management of patients suffering with refractory migraine. These patients are often quite disappointed with their treatment outcomes, making it difficult to communicate that further treatment may lead to improvements in symptoms. This is especially complicated by the many factors that may affect the efficacy of a treatment, including ensuring that the patient has received a correct diagnosis of a specific headache type, or determining whether treatment is being hampered by medication overuse. All of these issues require a thorough patient history, which is not always available. For Dr Dermitzakis, it is important to know what medication the patient received, and how long they used it for. These headaches are difficult to manage, and finding the right treatment requires perseverance and regular monitoring by the doctor.
“The opportunities of management have increased in recent years.”
Finally, Dr Dermitzakis has a message of hope for patients who have suffered with migraine for a significant period of time. Alongside medication for migraine, other treatments are becoming more readily available, including neurostimulation, physical therapy and referral to a psychologist for chronic pain and anxiety management. With the increasing knowledge of pharmacological and non‑pharmacological treatments for migraine, the opportunities to manage the treatment of migraine continue to expand.
