A randomized trial of rizatriptan in migraine attacks in children

Ahonen, Kati; Hämäläinen, Mirja; Eerola, Mervi; Hoppu, Kalle

doi:10.1212/01.wnl.0000238179.79888.44

Cited by 105 publications

(71 citation statements)

References 19 publications

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“…5,8 Despite this, studies in adults have shown triptans to be effective as abortive therapy in the ED setting, 25 but there have not been any ED-based pediatric studies. The evidence for pediatric use of triptans in the outpatient setting is strong, [26][27][28][29] yet only 3% of children received a triptan in the current study.…”

Section: Discussionmentioning

confidence: 67%

A Comparison of Acute Treatment Regimens for Migraine in the Emergency Department

2015

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BACKGROUND AND OBJECTIVES: Migraine headache is a common pediatric complaint among emergency department (ED) patients. There are limited trials on abortive therapies in the ED. The objective of this study was to apply a comparative effectiveness approach to investigate acute medication regimens for the prevention of ED revisits. METHODS:Retrospective study using administrative data (Pediatric Health Information System) from 35 pediatric EDs (2009EDs ( -2012. Children aged 7 to 18 years with a principal diagnosis of migraine headache were studied. The primary outcome was a revisit to the ED within 3 days for discharged patients. The primary analysis compared the treatment regimens and individual medications on the risk for revisit. RESULTS:The study identified 32 124 children with migraine; 27 317 (85%) were discharged, and 5.5% had a return ED visit within 3 days. At the index visit, the most common medications included nonopioid analgesics (66%), dopamine antagonists (50%), diphenhydramine (33%), and ondansetron (21%). Triptans and opiate medications were administered infrequently (3% each). Children receiving metoclopramide had a 31% increased odds for an ED revisit within 3 days compared with prochlorperazine. Diphenhydramine with dopamine antagonists was associated with 27% increased odds of an ED revisit compared with dopamine antagonists alone. Children receiving ondansetron had similar revisit rates to those receiving dopamine antagonists. CONCLUSIONS:The majority of children with migraines are successfully discharged from the ED and only 1 in 18 required a revisit within 3 days. Prochlorperazine appears to be superior to metoclopramide in preventing a revisit, and diphenhydramine use is associated with increased rates of return.WHAT'S KNOWN ON THE SUBJECT: Migraine headaches are a common presenting complaint in emergency departments. Abortive treatment in this setting is not well studied, leading to considerable variation in treatment. The relationship between acute medications and emergency department revisits has not been studied. WHAT THIS STUDY ADDS:Eighty-five percent of children with migraine are successfully discharged from the emergency department; only 1 in 18 children require a return visit. Prochlorperazine is associated with less revisits than metoclopramide, and diphenhydramine use is associated with increased risk of return visits.

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Section: Discussionmentioning

confidence: 67%

A Comparison of Acute Treatment Regimens for Migraine in the Emergency Department

2015

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“…50 Rizatriptan (5 mg for body weight 20-39 kg, 10 mg >40 kg) has also been evaluated in 96 young patients aged 6-17 years in a double-blind, placebo-controlled, cross-over trial. 51 Patients receiving either dose of rizatriptan achieved headache relief by two grades at 2 hours compared with placebo (p<0.001). Rizatriptan was superior at 3 and 4 hours and was consistent over two treated attacks.…”

Section: Rizatriptanmentioning

confidence: 97%

Overview of Triptans in the Treatment of Acute Migraine

Cortelli¹,

Allais²,

Benedetto³

2017

European Neurological Review

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T he advent of triptans for effective relief of migraine represented a therapeutic breakthrough. Triptans are serotonin (5-hydroxytryptamine, or 5-HT) agonists with high affinity for 5-HT 1B and 5-HT 1D receptors. There are, at present, seven commonly used triptans: almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan. Some controversy still surrounds the mode of action of this class. When first studied, it was thought that triptans provided relief from migraine through cranial vasoconstriction, probably via action at postsynaptic 5-HT 1B receptors on the smooth-muscle cells of blood vessels. More recently, however, triptans have also been demonstrated to block release of vasoactive peptides from the perivascular trigeminal neurons owing to their action at presynaptic 5-HT 1D receptors on the nerve terminal. Triptans may also facilitate descending pain inhibitory systems. However, it is not certain whether or not the activation of vascular 5-HT 1B receptors is essential for relieving migraine. Many drug characteristics need to be taken into account when selecting the best triptan for an individual patient. Clinical characteristics of the migraine attack and the patient's lifestyle and medical history are also important. Despite their biochemical similarity, triptans have distinct pharmacokinetic and pharmacodynamic profiles. Frovatriptan and naratriptan, for example, have a longer half-life and therefore a delayed onset of action and prolonged duration compared with the other triptans, which are fast acting, with a rapid dose-dependent efficacy and higher risk of adverse events and migraine recurrence. Migraine recurrence is affected by the pharmacological and pharmacokinetic properties of the triptan but is unrelated to initial clinical efficacy. Triptans with a longer half-life and largest 5-HT 1B receptor affinity have the lowest rates of headache recurrence.

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“…Studies uniformly showed high efficacy and safety, but mostly failed to show advantage over placebo with 2 exceptions [Ahonen et al, 2004[Ahonen et al, , 2006.…”

Section: Triptan Trials In Children and Adolescentsmentioning

confidence: 99%

“…* Sumatriptan NS [Ueberall et al, 1999], N 5 14, 85% * Sumatriptan NS [Ahonen et al, 2004], N 5 83, 69% * Sumatriptan NS [Winner et al,2000], N 5 510, 63% * Sumatriptan PO [Hamalainen et al, 1997], N 5 23, 30% * Sumatriptan PO [Winner et al, 1997], N 5 302, Unstated * Naratriptan PO [Rothner et al, 1997], N 5 300, 72% * Rizatriptan PO [Winner et al, 2002], N 5 296, 66% * Rizatriptan PO [Ahonen et al, 2006], N 5 96, 74%…”

Section: Triptan Trials In Children and Adolescentsmentioning

confidence: 99%

Triptans in children and adolescents

Gladstein

2007

Drug Development Research

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The advent of triptans in the 1990 s changed the approach to treating the migraine sufferer. Before triptan drugs, an acute attack of migraine was treated with drugs to put the patient to sleep until the migraine passed. This rendered the patient unable to resume activities such as school or work. Migraineurs had significant morbidity from treated as well as untreated attacks. With the use of this class of medications, headache could be treated quickly without the accompanied sedation from the medications. This has allowed people to get back to their busy lives, and migraine disability from medications has been lowered. Unfortunately, pediatric triptan trials have for the most part failed to demonstrate efficacy when compared to placebo. Nevertheless, these drugs are used for children and adolescents without FDA approval. Study design and consent adapted form adult studies may have made the placebo response rate higher than it needed to be. Drug Dev Res 68: 346-349, 2007.

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A randomized trial of rizatriptan in migraine attacks in children

Abstract: Oral rizatriptan is effective and well-tolerated for migraine attacks in children over age 6 years.

Cited by 105 publications

References 19 publications

A Comparison of Acute Treatment Regimens for Migraine in the Emergency Department

A Comparison of Acute Treatment Regimens for Migraine in the Emergency Department

Overview of Triptans in the Treatment of Acute Migraine

Triptans in children and adolescents

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