Comparison between the effects of sumatriptan versus naratriptan in the treatment of postdural puncture headache in obstetric patients: A randomized controlled trial

Abstract

Background: Postdural puncture headache (PDPH) in the obstetric anesthesia practice is one of the most annoying, common, and important problems. Aim: This comparative study was designed to assess the efficacy of naratriptan in relieving PDPH in parturients who gave birth by cesarean section under intrathecal anesthesia and to compare its efficacy with sumatriptan. Settings and Design: One hundred and eighty-nine adult parturients who complained of PDPH in the first 3 days postpartum period were enrolled in this study. They were divided into three equal parallel groups of 63 each. Materials and Methods: Group-1 controlled (C-group) received multivitamin tablets, Group-2 sumatriptan (S-group) received sumatriptan tablets and Group-3 naratriptan (N-group) received naratriptan tablets. The efficacy of naratriptan in relieving PDPH was studied and compared with that of sumatriptan. Incidences of complications of both drugs were also noted. Statistical Analysis: The collected data were organized, tabulated, and statistically analyzed using SPSS software statistical computer package version 18 (SPSS Inc., USA). Results: After the first 6 h, there were statistically significant differences between Groups S and N from one side and control group from the other side ( P < 0.0001 and 0.001), respectively, and the difference between Group S and Group N was statistically significant ( P = 0.004). After 12 h, there were statistically significant differences between Groups S and N from one side and the control group from the other side ( P < 0.0001) and the difference between Group S and Group N was statistically significant ( P = 0.002). After 72 h, there were statistically significant differences between Groups S and N from one side and control group from the other side ( P < 0.001 and 0.009), respectively. The difference was nonsignificant between S and N group ( P = 0.717). Conclusion: The study revealed that anti-migraine drug naratriptan in combination with supportive treatment was effective in relieving PDPH in parturients.

Is theophylline more effective than sumatriptan in the treatment of post-dural puncture headache? A randomized clinical trial

“…A recent randomized clinical trial conducted by Botros and Sayed, [21] on 189 parturients with PDPH, reported significant decreases in the pain scores in the oral sumatriptan group than in the oral naratriptan and placebo groups at 6 h.; 1 (1-2) vs 2 (1-2) P < 0.007 and 3 (2-3) P < 0.001, at 12 h.; 1 (0-2) vs 2 (1-2) P < 0.005 and 2 (2-3) P < 0.001, at 24 h.; 0 (0-1) vs 1 (0-2) P < 0.019 and 2 (1-2) P < 0.001, at 48 h.; 0 (0-0) vs 0 (0-1) P = 0.137 and 2 (1-2) P < 0.001, respectively. These results were lower than the present study, which can be explained by the usage of a large dose of oral sumatriptan (50 mg, q12h in the 1 st day, then q24h) and giving oral caffeine-containing drinks like coffee and tea, to all their studied groups.…”

“…In contrast, sumatriptan-related side effects in the current study were comparable to a recent study that demonstrated insignificant incidences of nausea, vomiting, and dizziness, and the incidences of tingling and tightness were significantly higher in the naratriptan group than in the other two groups. [21] To the best of our knowledge, this was the first randomized clinical trial that compared oral theophylline versus oral sumatriptan and using lower doses of each drug in the treatment of PDPH.…”

Post-dural puncture headache: Epidemiology, onset mechanisms, clinical symptoms, diagnosis and therapy

“…There are individual case reports, and case series about the use of sumatriptan in PDPH therapy with a favourable therapeutic response, but there is no sufficient evidence to suggest that its use can be recommended as standard therapy. Frovatriptan has been found effective in the prevention of PDPH, but these results also need to be confirmed by well-designed studies [47][48][49].…”

Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group

“…195 196 Other medications shown to decrease the severity of symptoms include gabapentinoids, 186 theophylline [197][198][199] and hydrocortisone, [200][201][202] but multiple study weaknesses such as small numbers, patient demographics (obstetric/non-obstetric, age, gender, etiology of dural puncture not specified, insufficient methodology and potential for bias) limit their interpretation. Other medications, including triptans, [203][204][205] ACTH/cosyntropin, [206][207][208] neostigmine/atropine, 209 piritramide 210 and methergine, 211…”