Efficacy of almotriptan in early intervention for treatment of acute migraine in a primary care setting: the START*study

Abstract

Summary Aims: The benefits of taking almotriptan early for acute migraine when pain is mild have clearly been demonstrated in the neurology setting. The aim of this study was to determine whether similar benefits with early intervention of almotriptan can be achieved in everyday general practice, where most migraineurs are managed. Methods: In this European, prospective, observational study, patients were asked to treat up to three migraine attacks over a 2‐month period with almotriptan 12.5 mg administered within 1 h of pain onset and when pain was mild (early + mild intervention group). Results: A total of 501 patients were enrolled in primary care centres across Spain, France and Italy. The intention‐to‐treat analysis involved 454 patients who reported 1174 migraine attacks, with early intervention being used in 138 of these attacks. A greater proportion of patients who took almotriptan early + mild for their first migraine attack (n = 42) were pain free at 2 h compared with those in the non‐early + mild intervention group (n = 410) (62% vs. 35%; p < 0.001). Similar results were obtained for all migraine attacks comparison [65% (n = 138) vs. 38% (n = 1036); p < 0.001]. Other secondary end‐points were also significantly in favour of early + mild treatment, including sustained pain free (SPF), SPF with no adverse events (SNAE), and time lost because of migraine (all p < 0.001). Almotriptan was well tolerated with no serious adverse events reported. Conclusions: In the primary care setting, early intervention with almotriptan for treatment of migraine provides significant clinical benefits compared with delaying treatment and/or waiting until pain intensity has progressed beyond mild.

Almotriptan Malate: Early Treatment in Acute Migraine

“…[11][12][13][14][15] Adverse event rates are similar to placebo 13,16 and there was no significant difference in overall adverse event rates reported in those who treated the migraine headache early compared to late. 12,15 Only two of the four early treatment studies reported premature discontinuation rates. 12,13 (See Table 1) The first was a head to head comparison of early to standard treatment with almotriptan.…”

“…15 Patients were 18 to 65 years of age and had migraines with or without aura of at least moderate intensity for at least 1 year. They had to have 2 to 6 migraines per month for the last three months to be included in the trial.…”

Treatment of migraine: update on new therapies

“…Almotriptan 12.5 mg was found effective for their treatment, producing a 48.4% 2-h-pain-free rate and 2-24-h-sustained pain-free in most patients [19]. In the START study [20], 1174 migraine attacks were treated with almotriptan 12.5 mg within 1 h of pain onset and when pain was mild.…”

Therapie der Migräneattacke und Prophylaxe der Migräne

“…Triptane können zu jedem Zeitpunkt innerhalb der Attacke wirken, das heißt, sie müssen nicht notwendigerweise unmittelbar zu Beginn der Schmerzphase eingenommen werden. Triptane wirken umso besser, je früher sie in einer Migräneattacke eingenommen werden (73)(74)(75)(76)(77)(78). Um der Entwicklung eines Kopfschmerzes durch Medikamentenübergebrauch vorzubeugen, sollte eine frühe Einnahme nur empfohlen werden, wenn die Attacken nicht zu häufig sind (< 10 Kopfschmerztage pro Monat) und wenn der Patient eindeutig seinen Kopfschmerz als Migräneattacke identifizieren kann.…”