Early treatment of migraine with rizatriptan: a placebo-controlled study.
ABSTRACT To evaluate the efficacy of rizatriptan when administered early during a migraine attack.
Several studies indicate that triptans are more efficacious when administered early during a migraine attack, when the pain is still mild.
One hundred and twelve rizatriptan-naïve patients aged 20 to 64 years with a history of migraine with or without aura that progressively worsened when left untreated were instructed to treat a total of three migraine attacks with either rizatriptan 10 mg or placebo as early as possible during each attack. Seventy-four patients (68 women and 6 men) were assigned to use the active drug and 38 (35 women and 3 men) to placebo. The primary efficacy endpoint was pain-free response at 2 hours after administration of the study drug. Secondary efficacy measures were pain-free response at 1 hour and sustained pain-free response lasting between 2 and 24 hours.
A total of 216 attacks were treated in the rizatriptan group and 109 in the placebo group. Pain-free response at 2 hours after early treatment was noted in 151 (70%) of attacks in the rizatriptan group and in 24 (22%) in the placebo group (P < .01). Pain-free response at 1 hour occurred in 97 (45%) and 9 (8%) attacks, respectively (P < .01). When the attacks were categorized by headache severity at the time of treatment, the pain-free response at 2 hours was higher for mild attacks than for moderate or severe attacks (P < .01). Sustained pain-free response after treatment was significantly higher for attacks treated with rizatriptan (60%) than for those treated with placebo (17%) (P < .001). Adverse events were observed in 62 patients in the rizatriptan group and 15 in the placebo group. Only 1 patient taking rizatriptan discontinued the study because of adverse events, and no serious adverse events were reported.
Rizatriptan is significantly more likely than placebo to produce a pain-free response within 2 hours when the drug is administered early in the migraine attack, when pain is mild rather than moderate or severe.
- SourceAvailable from: Rob Janknegt
Article: Triptans in the treatment of migraine: drug selection by means of the SOJA methodThis paper is based on: JANKNEGT R, VAN DER KUY PHM, LOHMAN JJHM et al.: Triptans in the treatment of migraine. Drug selection by means of the system of objectifi ed judgement analysis (SOJA) method. J. Drug Asses. (2000) 3 :S65-S82.[Show abstract] [Hide abstract]
ABSTRACT: In this paper, drug selection of triptans for the treatment of migraine is performed by means of the SOJA method, which prospectively defines and scores selection criteria. All drugs available in the Netherlands were included in the analysis. The following selection criteria were used (relative weight between brackets): approved indications (40), number of formulations (50), variability of bioavailability (40), drug interactions (85), clinical efficacy (415), side effects (190), acquisition cost (75) and documentation (105). Almotriptan, rizatriptan and sumatriptan show the highest scores, and are the most suitable triptans for formulary inclusion.Expert Opinion on Pharmacotherapy 10/2007; 8(s1). · 2.86 Impact Factor
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ABSTRACT: OBJECTIVES: To investigate the factors that influence a migraineur's beliefs regarding oral triptans for the acute treatment of migraines and to provide further insight into patients' decision-making process when faced with migraine. METHODS: A multicenter, cross-sectional, observational study of subjects currently prescribed an oral triptan medication for the acute treatment of migraine headaches. Subjects were recruited from 6 headache clinics and one primary care practice in the United States. Enrolled subjects completed a questionnaire that could be completed either at the site as part of the visit or at home. The questionnaire comprised 27 questions assessing demographic characteristics, migraine history, migraine frequency and severity, and general beliefs about migraine treatments. The study population was stratified into 2 cohorts (Early Treatment and Delayed Treatment) based on how they typically use their oral triptan to treat a typical migraine. RESULTS: A total 506 subjects were enrolled in the study, of which 502 were stratified into the Early Treatment cohort (41.2%) and Delayed Treatment cohort (58.8%). Demographic and clinical characteristics were generally similar between the 2 cohorts. In terms of general treatment patterns, there were notable differences between the Delayed and Early Treatment cohorts, with the Delayed Treatment cohort significantly more likely to take an over-the-counter (OTC) or non-triptan medication first (P ≤ .001) and only take a triptan if the OTC or non-triptan medication did not work (P ≤ .001). Furthermore, 55% of the Delayed Treatment cohort delayed taking a triptan to be certain that the headache was a migraine (vs 32% of the Early Treatment cohort; P ≤ .001). When asked to specify the reasons for delaying treatment with a triptan, the Delayed Treatment cohort had, in general, greater concerns about using their oral triptan in comparison with the Early Treatment cohort. In particular, respondents were primarily concerned with running out of their triptan medication with 35% of the Delayed Treatment cohort expressing this concern compared with 22% of the Early Treatment cohort (P ≤ .001). Statistically significant differences were also noted for concerns about taking medications (P ≤ .001), side effects (P ≤ .05), expense (P ≤ .01), and taking prescription medications (P ≤ .001). CONCLUSIONS: Results build upon previously published studies and suggest that patient beliefs directly influence how migraineurs manage their migraines and have implications for patient outcomes. Such insights should be used to facilitate physician-patient communication and reinforce the need for patient-centered care to improve patient outcomes.Headache The Journal of Head and Face Pain 06/2013; · 2.94 Impact Factor
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ABSTRACT: Introduction Triptans, ergotamine derivatives and nonsteroidal anti-inflammatory drugs are front-line agents used in the acute abortive therapy of migraines. In this article, these medications are reviewed and a treatment algorithm suggested.Canadian Pharmacists Journal 07/2009; 142(4):190-198.e1.