Frovatriptan for The Prevention of Postdural Puncture Headache
Bussone G, Tullo V, d'Onofrio F, Petretta V, Curone M, Frediani F, Tonini C & Omboni S. Frovatriptan for the prevention of postdural puncture headache. Cephalalgia 2007; 27:809–813. London. ISSN 0333-1024 Efficacy of 5-day treatment with oral frovatriptan 2.5 mg/die for the prophylaxis of post-dural puncture headache (PDPH) was tested in 50 in-patients. A mild headache occurred in 7 (14%) patients for a total of 9 days (p < 0.01 vs. no-PDPH). Most episodes of PDPH occurred in the first days of treatment (only 1 patient had headache at dismissal): 5 patients had only 1 episode, while 2 had headache for 2 consecutive days. No other symptoms were recorded. Occurrence of PDPH in a subgroup of 6 (12%) patients previously submitted to a diagnostic lumbar puncture was also examined: 4 of them reported a PDPH on the previous lumbar puncture in absence of triptans. In only 1 of these 4 patients PDPH recurred under treatment with frovatriptan. In conclusion, our non-randomized open-label study suggests efficacy of oral frovatriptan for PDPH prevention. These results need to be confirmed in a randomized, controlled, double-blind study.
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- [Show abstract] [Hide abstract] ABSTRACT: Frovatriptan belongs to the triptan compounds used for the acute treatment of migraine. Its affinity for the migraine-specific serotonin 5HT1B-receptors is highest in the class. Its long half-life in plasma (26 h) and metabolism by multiple pathways are unique characteristics among the triptans. These features can translate into long duration of action and low risk of interactions with other drugs. Frovatriptan has been effective and well tolerated over a wide range of doses in randomised, double-blind, placebo-controlled acute migraine trials and long-term, open-label trials. The 2.5-mg dose is recommended for both efficacy and a favourable side effect profile for acute migraine treatment. Frovatriptan has the lowest headache recurrence rate of all the triptans. Frovatriptan was better tolerated than sumatriptan in a head-to-head comparison study. Frovatriptan could make its mark especially in slowly progressing migraine attacks and in attacks that are highly predictable. For example, for the short-term prophylaxis of menstrual migraine, frovatriptan is the triptan of first choice.0Comments 20Citations
- [Show abstract] [Hide abstract] ABSTRACT: Frovatriptan is a 5-HT(1B/1D) receptor agonist that belongs to the triptan therapeutic class. Relative to other triptans, frovatriptan has a long half-life (26 h) and a low incidence of migraine recurrence (17%). Frovatriptan is indicated for the acute treatment of migraine with or without aura, and has a relatively good safety and tolerability profile. Recent studies have also shown that a 6-day regimen of frovatriptan scheduled during the perimenstrual period significantly reduced the incidence and severity of menstrual migraine (MM; attacks that regularly start day -2 to +3 relative to menses). Prevention may be important because MM attacks have been characterized as being of longer duration, more severe and more refractory to treatment than non-MM attacks.0Comments 3Citations
- [Show abstract] [Hide abstract] ABSTRACT: The treatment of postdural puncture headache remains controversial, largely because it is insufficiently evidence based. With high rates of neuraxial block in the obstetric population likely to continue, postdural puncture headache will remain a primary cause of morbidity and increased duration of hospital stay. This review describes new reports of relevance published in 2006 and until October 2007. New evidence justifies epidural blood patch as the treatment of choice for severe postdural puncture headache, but technical aspects such as optimal timing and volume are less clear. Symptomatic medical management remains diverse, with a multitude of therapies often advocated, despite a lack of scientific support. Reports of misdiagnosis and of complications associated with postdural puncture headache and its treatment emphasize the importance of multidisciplinary management and additional investigation, including radiological imaging, when the clinical picture warrants. The key reports in this epoch have shed light on the benefits of careful assessment of postpartum headache and treatment with an epidural blood patch. New management paradigms have been suggested and serious complications continue to be reported.0Comments 25Citations