Are Certain Migraine Drugs Going Underused?

Findings from a new study suggest that more migraines could be treated safely with triptans and dihydroergotamine (DHE), 2 classes of medications used to combat migraines that also carry warnings regarding stroke risk.

A team including researchers from Abington Hospital and Thomas Jefferson University conducted a retrospective review of patients with basilar migraine (BM) features or hemiplegic migraine (HM) who received acute abortive treatment with either triptans or DHE. The investigators conducted the review at 4 headache centers  in an effort to evaluate the frequency of ischemic vascular events after administration. Diagnoses of BM or HM were made by headache specialists, based on the International Classification of Headache Disorders, 2nd edition.
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The study included 67 patients with BM features and 13 patients with HM. Forty in the BM group and 5 in the HM group were receiving triptans, while 27 in the BM group and 8 in the HM group were taking DHE. According to the authors, no adverse effects of stroke or myocardial infarction were reported.

Among patients in the triptan group, 5 patients indicated adverse effects, including gastrointestinal tract upset, rash, neck dystonia, nightmares, and flushing. In the DHE group, 5 patients experienced adverse events such as chest tightness, dystonic reaction, transient asymptomatic anterior T-wave inversion, and agitation.

Overall, triptans and DHE were used with no reported subsequent acute or subacute ischemic vascular events for the abortive treatment of migraines with basilar and hemiplegic-type features.

“Migraine is a complex neurological disorder,” said Brad Klein, MD, medical director of the Headache Center at Abington Hospital-Jefferson Health, and a senior author of the study.

While noting that blood vessels were once thought to be the cause of migraine, “research suggests that the auras of migraine are a result of neuronal activation, not vascular changes,” he said.

As a result, “there appears to be no clear reason that triptans and DHE could not be used in these patient populations.”

“Healthcare providers should be more comfortable understanding migraine and [should] be more comfortable providing the right treatment for these patients, because there is now more research to support their decisions,” Klein said.

—Mark McGraw

Reference

Mathew PG, Krel R, Buddhdev B, et al. A retrospective analysis of triptan and DHE use for basilar and hemiplegic migraine. Headache. 2016;56(5):841-848.