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Two Triptans Appear Effective in Reducing Incidence of Menstrually Associated Migraine: Presented at IHC

By Larry Schuster

ROME, ITALY -- September 29, 2003 -- Studies of 2 triptans show the drugs appear to prevent menstrually-associated migraine for many women in the trials.

The studies were presented here September 16^th at the 11^th Congress of the International Headache Society.

In one study of more than 500 patients, frovatriptan reduced incidence of menstrually related migraine, defined as migraine with usual onset on days 3 or 4 of the period, and true menstrual migraine, defined as migraines first occurring 2 days before the anticipated first day of menstrual flow, and continuing through day 2, and occurring at no other time.

Coauthor Arthur Elkind, MD, Elkind Headache Center, Mount Vernon, New York, United States, presented the randomised, double-blind, placebo-controlled, crossover study involving non-pregnant, non-breast-feeding women, with a history of menstrually associated migraine (MAM) for at least 12 months, and MAM attacks in at least 3 of every 4 perimenstrual periods.

The women had been suffering from MAM for a mean time of more than 10 years; some had it for as many as 40 years. Most women in the study had previous triptan use.

The women received treatments in random order of frovatriptan 2.5 mg qd, 2.5 mg bid, or placebo. Treatments were given for 6 days, starting 2 days prior to the anticipated onset of MAM.

The incidence of MAM in patients with true menstrual migraine was 38.4% with frovatriptan 2.5 mg bid, 52.4% with frovatriptan 2.5% qd, and 66.2% for placebo.

The incidence of menstrually-association symptoms -- photophobia, phonophobia, nausea, and vomiting -- in patients with true menstrual migraine was 37.1% with the 2.5 mg dose, 51.7% with the 2.5 mg qd dose, and 63.6% with placebo.

The incidence of moderate or severe functional impairment in patients with true menstrual migraine was 13.3% with 2.5 mg., 23.8% with 2.5 mg, and 32.5% with placebo.

The drug also appeared to have a similar dose-related effect in patients with MAM, with up to 3 non-MAM migraine attacks per month. However, the effect in each case was less striking compared to those with true menstrual migraine.

The overall incidence of adverse events was slightly higher with frovatriptan compared to placebo. More than 90% of adverse events were of mild or moderate severity; nausea, dizziness, and headache were the most commonly reported adverse events.

Frovatriptan has a half-life of about 26 hours, which appears to contribute to the low rate of recurrence when compared with other triptans, the authors said.

Two other trials of more than 600 women found naratriptan effective as an intermittent prophylaxis for MAM. Jan Brandes, MD, Nashville Neuroscience Group, Nashville, Tennessee, United States, reported on the results of 2 randomised, double-blind, placebo controlled, international trials in women who reported regularly occurring MAM. They defined MAM as a migraine beginning during the perimenstrual period, which includes the period of 2 days before, and 4 days after the start of menstrual flow.

In their trials, a total of 311 women received placebo, and 322 received 1 mg naratriptan bid for 6 days; 38% of the women in the treated group were free of migraine attacks on the days they were on the drug during the first treated perimenstrual period, compared to 20% on placebo.


[Study titles: Efficacy of Menstrually Associated Migraine Prophylaxis With Frovatriptan in True Menstrual Migraine Patients and in Patients With Menstrually Related Migraine. P5N55: Naratripan vs. Placebo for Intermittent Prophylaxis for Menstrually Associated Migraine (MAM): Analyses of Migraine-Free Days. Abstract P5N24]

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