AAN: Preventive Drugs Reduce Severity of Menstrual Migraine
April 28th 2010 19:48
Sometimes too much
Medical News:
By Kristina Fiore, Staff Writer, MedPage Today
Published: April 29, 2009
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston.
Giving patients eletriptan or sumatriptan in a preventive fashion decreased menstrual migraine incidence, severity, and duration in an open-label, randomized controlled trial, with a slight advantage reported for eletriptan.
Note that this study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
In an open-label, randomized prospective study, both drugs reduced the incidence, severity, and duration of menstrual migraine, although eletriptan had a slight advantage, according to David Dolezil, M.D., Ph.D., of University Hospital Ostrava in the Czech Republic.
Dr. Dolezil said that menstrual migraine attacks may be more severe and less responsive to treatment than migraine that occurs at other times of the menstrual cycle.
Although triptans are short-acting drugs recommended for treating migraine after symptom onset, some physicians use them off-label to prevent these headaches in women who regularly get menstrual migraine.
Half were randomized to 40 mg of eletriptan and half to 50 mg of sumatriptan, receiving treatment a day before the onset of menses and three days thereafter for three consecutive menstrual periods.
The researchers found that incidence of menstrual migraine was reduced in both groups compared with the pretreatment period (44% for eletriptan, 51% for sumatriptan).
Both drugs reduced headache severity compared with pretreatment period, although eletriptan was superior to sumatriptan, Dr. Dolezil said (34% reduction versus 26%).
Duration of menstrual migraine was also reduced in both groups, dropping to 32 hours for patients on eletriptan and 36 hours for those on sumatriptan, compared to a baseline mean duration of 52 hours.
Common adverse reactions included paresthesia, vertigo, and nausea, Dr. Dolezil said, although both drugs were well tolerated overall and there were no severe adverse reactions.
"Preventing menstrual migraine is difficult to do," said Richard Foa, M.D., of Northwest Neurology in Wheat Ridge, Colo., who was not involved in the study.
He said he prescribes frovatriptan in a preventive fashion for his menstrual migraine patients.
"I don't feel the data will modify practice," he said. "But this is something I would try if my patients found another treatment ineffective."
Action Points
Giving patients eletriptan or sumatriptan in a preventive fashion decreased menstrual migraine incidence, severity, and duration in an open-label, randomized controlled trial, with a slight advantage reported for eletriptan.
Note that this study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
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