Efficacy of frovatriptan and other triptans in the treatment of acute migraine of normal weight and obese subjects: a review of randomized studies

Abstract

An association between obesity and migraine has been observed in recent studies and it is supported by plausible biological mechanisms. The objective of this study is to evaluate the efficacy of frovatriptan and other triptans in the acute treatment of migraine, in patients enrolled in three randomized, double-blind, crossover, Italian studies and classified according to body mass index (BMI) levels, as normal weight or non-obese (NO, BMI 18.5-24.9 kg/m(2)) and overweight or obese subjects (O, BMI ≥ 25 kg/m(2)). 414 migraineurs with or without aura were randomized to frovatriptan 2.5 mg or rizatriptan 10 mg (study 1), frovatriptan 2.5 mg or zolmitriptan 2.5 mg (study 2), frovatriptan 2.5 mg or almotriptan 12.5 mg (study 3). After treating up to three episodes of migraine in 3 months with the first treatment, patients switched to the alternate treatment for the next 3 months. The present analysis assessed triptan efficacy in 220 N and in 109 O subjects of the 346 individuals of the intention-to-treat population. The proportion of pain free at 2 h did not significantly differ between frovatriptan and the comparators in either NO (30 vs. 34 %) or O (24 vs. 27 %). However, the rate of pain free at 2 h was significantly (p < 0.05) larger in NO than in O, irrespective of the type of triptan. Pain relief at 2 h was also similar between drug treatments for either subgroup. Pain relapse occurred at 48 h in significantly (p < 0.05) fewer episodes treated with frovatriptan in both NO (26 vs. 36 %) and O (27 vs. 49 %). The rate of 48-h relapse was similar in NO and O with frovatriptan, while it was significantly (p < 0.05) higher in O with the comparators. Frovatriptan, in contrast to other triptans, retains a sustained antimigraine effect in NO and even more so in O subjects.

Predicting Inadequate Response to Acute Migraine Medication: Results From the American Migraine Prevalence and Prevention (AMPP) Study

“…High BMI has been associated with severe and progressive forms of migraine in previous studies and may reflect a pro‐inflammatory state in obesity that renders treatment less effective. Inadequate 2hPF rates have been demonstrated in obese participants compared with normal‐weight subjects for triptans . Among headache characteristics, average headache pain intensity and the presence of cutaneous allodynia were associated with inadequate response at 2 hours, but monthly headache day frequency was not.…”

“…Inadequate 2hPF rates have been demonstrated in obese participants compared with normal-weight subjects for triptans. 20 Among headache characteristics, average headache pain intensity and the presence of cutaneous allodynia were associated with inadequate response at 2 hours, but monthly headache day frequency was not. Prior studies suggest that baseline pain intensity and cutaneous allodynia predict a poor response to acute treatment.…”

Obesity and Chronic Pain

“…182 Similarly, frovatriptan, in contrast to other triptans, retained a sustained antimigraine effect on obese subjects, possibly because of its longer half-life. 183 Chronic pain pharmacotherapy should address the concerns of obese patients about iatrogenic weight gain associated with some commonly used pain medications, such as gabapentin or pregabalin. One study showed that about 80% of patients taking 150 to 600 mg/d pregabalin for 1 year maintained their weight within 7% of baseline, but the remainder experienced more than 7% weight gain, and no one had weight loss.…”

Presence and Clinical Value of Vestibular Symptoms in Migraine

“…In drug clinical trials, the choice of the frequency of headache used to de ne episodic migraine in trials of new drugs has always been a di cult problem. Some clinical trials chose a headache frequency from 3 to 8 days per month (23), some chose from 1 to 6 days per month (24), and some chose from 2 to 8 days per month (25). However, there is no relevant clinical research indicating the number of days that should be selected as the standard, the number of days that would be appropriate to select based on the study design, and the number of days that is the most common frequency among patients in the clinical setting.…”