Efficacy and tolerability of almotriptan versus zolmitriptan for the acute treatment of menstrual migraine

Abstract

Menstrual migraine (MM) attacks are a challenge for the headache specialist, because they are particularly difficult to treat. Almotriptan is a second-generation triptan successfully used for the acute treatment of migraine. No data on the efficacy and safety of almotriptan in MM treatment have been published previously. The objective was to evaluate the efficacy and tolerability of almotriptan in the symptomatic treatment of MM attacks and to compare these parameters to those obtained with zolmitriptan, another second-generation triptan. Data from a multicentre, multinational, randomised, double-blind, parallel clinical trial, conducted at 118 centres in 9 European countries, to evaluate the efficacy and tolerability of almotriptan 12.5 mg vs. zolmitriptan 2.5 mg in the acute treatment of migraine were analysed retrospectively. Of the 1061 patients included, 902 were women and 255 of these treated a MM attack: 136 with almotriptan and 119 with zolmitriptan. No significant difference between the two treatments was found. Two hours after dosing, 67.9% of almotriptan-treated and 68.6% of zolmitriptan-treated patients had obtained pain relief; while 44.9% and 41.2%, respectively, were pain free. Recurrence rates 2-24 h after dosing were 32.8% for almotriptan and 34.7% for zolmitriptan. Adverse events in the 24 h after dosing were reported by 19.8% of those taking almotriptan and 23.1% of those taking zolmitriptan. In conclusion, almotriptan is effective and safe in the treatment of MM attacks.

Short-Term Frovatriptan for the Prevention of Difficult-To-Treat Menstrual Migraine Attacks

“…In an analysis of 255 women treated acutely with zolmitriptan (n = 119) or almotriptan (n = 136) for MM, approximately one-third of patients did not achieve pain relief 2 h after treatment, < 50% were pain free 2 h postdose, and two-thirds did not report a sustained pain-free response (10). Likewise, in a placebo-controlled trial evaluating the efficacy of sumatriptan for MM, 40% of women did not achieve pain relief within 2 h of taking sumatriptan 100 mg, and only 31% achieved a sustained painfree response (11).…”

Perimenstrual headaches: Unmet needs

“…Similarly, Allais et al [43] reported that although acute triptan therapy for menstrual migraine provided effective pain-free relief at 2 hours in most women, a sustained pain-free state was achieved by fewer than 30% of patients. In contrast, studies of rizatriptan undertaken in women with menstrual migraine diagnosed according to ICHD-II criteria suggest equivalent effi cacy for menstrual versus nonmenstrual attacks [37••,44•].…”

Clinical aspects of perimenstrual headaches

“…Naratriptan studies were of poor quality with insuffi cient acute treatment effect, whereas almotriptan, eletriptan, and frovatriptan lacked prospective, double-blind, placebo-controlled studies. In a retrospective analysis of almotriptan versus zolmitriptan for MRM, equivalence between triptans was reported [30]. For frovatriptan, an open-label study reported by MacGregor and Keywood [31] in abstract form only revealed longer time to relief in MRM attacks (5.5 hours vs 3.6 hours to relief), and 60% of attacks required a second dose.…”