Efficacy of zolmitriptan nasal spray in adolescent migraine
ABSTRACT The goal was to evaluate the efficacy and tolerability of zolmitriptan nasal spray in the treatment of adolescent migraine.
The "Double-Diamond" study used a novel, single-blind, "placebo challenge" in a multicenter, randomized, double-blind, placebo-controlled, 2-way, 2-attack, crossover design. A total of 248 US adolescent patients (12-17 years of age) with an established diagnosis of migraine, with or without aura, were enrolled. A single-blind placebo challenge was used for each migraine attack. No additional medications were taken if a headache response to the initial placebo treatment was achieved at 15 minutes; if migraine intensity remained moderate or severe, then patients treated the attack with zolmitriptan (5 mg) nasal spray or placebo according to a randomized, crossover schedule (double-blind). The primary efficacy variable was headache response at 1 hour after treatment. A comprehensive range of secondary end points included sustained headache response at 2 hours.
A total of 171 patients (mean age: 14.2 years; 57.3% female) treated > or = 1 attack with study medication (intention-to-treat population). The onset of significant pain relief was apparent 15 minutes after treatment with zolmitriptan nasal spray. At 1 hour after the dose, zolmitriptan nasal spray produced a higher headache response rate than did placebo (58.1% vs 43.3%). Zolmitriptan nasal spray was also significantly superior to placebo in improvement in pain intensity, pain-free rates, sustained resolution of headache, and resolution of associated migraine symptoms. Return to normal activities was also consistently faster with zolmitriptan nasal spray than with placebo, with less use of any escape medication. Treatment with zolmitriptan nasal spray was well tolerated.
This novel, placebo-challenge study demonstrated that zolmitriptan nasal spray was well tolerated and provided fast and significantly effective relief of migraine symptoms in the acute treatment of adolescent migraine.
- SourceAvailable from: Ian M Paul
Advances in Pediatrics 01/2010; 57(1):163-83. DOI:10.1016/j.yapd.2010.08.004
- "In this trial, a 100-mg daily dose, but not a 50-mg daily dose, was found to be more effective than placebo for reducing rates of migraine headaches. For acute treatment of migraines, zolmitriptan nasal spray was studied in adolescents with a known diagnosis of migraine, with or without aura . At 1 hour after dosing, relief was seen by 58% of zolmitriptan-treated participants compared with only 43% of those treated with placebo for acute headache, and both pain reduction and sustained relief were better in the active drug arm. "
Article: Headaches.Clinical symposia (Summit, N.J.: 1957) 02/1981; 33(2):1-32.
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ABSTRACT: Migraine is a common, chronic neurologic disorder that affects approximately 12% of the adult population in Western countries. Once migraine is diagnosed, illness severity must be assessed. Clinicians and patients should then work together to develop a treatment plan based on patient needs and preferences. The goals of treatment usually include reducing the intensity and duration of acute attacks, minimizing the frequency of attacks, minimizing headache-related disability and maximizing health-related quality of life, and avoiding headache escalation and medication misuse. Management of migraine is divided into pharmacologic and nonpharmacologic approaches. Pharmacologic approaches are subdivided into preventive treatment, taken on a daily basis whether or not headache is present, and acute drugs taken to treat individual attacks as they arise. Acute treatments are further divided into nonspecific agents, which work for all types of pain, and migraine-specific treatments. The US Headache Consortium Guidelines recommend stratified care based on the level of disability to help physicians individualize treatment. Using this approach means that simple analgesics are appropriate as first-line acute treatments for less-disabled patients; if simple analgesics are unsuccessful, treatment is escalated for high-end therapies (eg, triptans). For those with high disability levels, migraine-specific acute therapies, such as the triptans, are recommended as the initial treatment, with preventive drugs in selected patients. A variety of behavioral interventions are helpful. The clinician has an armamentarium of ever-expanding variety of medications. With experience, clinicians can match individual patient needs with the specific characteristics of a drug to optimize therapeutic benefit.Current Treatment Options in Neurology 12/2003; 5(6):423-430. DOI:10.1007/s11940-996-0011-0 · 2.18 Impact Factor