European Headache Federation (EHF) consensus on the definition of effective treatment of a migraine attack and of triptan failure

Abstract

Background Triptans are migraine-specific acute treatments. A well-accepted definition of triptan failure is needed in clinical practice and for research. The primary aim of the present Consensus was to provide a definition of triptan failure. To develop this definition, we deemed necessary to develop as first a consensus definition of effective treatment of an acute migraine attack and of triptan-responder. Main body The Consensus process included a preliminary literature review, a Delphi round and a subsequent open discussion. According to the Consensus Panel, effective treatment of a migraine attack is to be defined on patient well-being featured by a) improvement of headache, b) relief of non-pain symptoms and c) absence of adverse events. An attack is considered effectively treated if patient’s well-being, as defined above, is restored within 2 hours and for at least 24 hours. An individual with migraine is considered as triptan-responder when the given triptan leads to effective acute attack treatment in at least three out of four migraine attacks. On the other hand, an individual with migraine is considered triptan non-responder in the presence of failure of a single triptan (not matching the definition of triptan-responder). The Consensus Panel defined an individual with migraine as triptan-resistant in the presence of failure of at least 2 triptans; triptan refractory, in the presence of failure to at least 3 triptans, including subcutaneous formulation; triptan ineligibile in the presence of an acknowledged contraindication to triptan use, as specified in the summary of product characteristics. Conclusions The novel definitions can be useful in clinical practice for the assessment of acute attack treatments patients with migraine. They may be helpful in identifying people not responding to triptans and in need for novel acute migraine treatments. The definitions will also be of help in standardizing research on migraine acute care.

Simultaneous Comparisons of 25 Acute Migraine Medications Based on 10 Million Users' Self-Reported Records From a Smartphone Application

“…The European Headache Federation recently published a consensus statement on the definition of effective treatment of a migraine attack which includes improvement of headache, relief of nonpain symptoms, and absence of adverse events. 19 Obtaining the above-mentioned information in the real-world setting could also be helpful to evaluate treatment effectiveness. Another limitation is that users may take multiple acute migraine medications during a migraine attack, but we do not have information on the order and timing of each medication intake during an attack because users were not required to enter that information, which limits our ability to analyze the effectiveness of medications taken first vs rescue.…”

Long COVID and especially headache syndromes

“…There are no specific studies aimed at investigating the effectiveness of nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids on reducing frequency and intensity of headache in COVID-19 patients, and treatment recommendations are based on the current management of headaches. Treatment goals are the reduction of number and intensity of headache crises, and the prevention of chronic forms, especially in patients with predisposition to headache [36,37].…”

The pharmacotherapeutic management of episodic and chronic migraine with gepants

“…Triptan ineligibility refers to the presence of a contraindication to triptan use. In the case of triptan failure, gepants represent a possible option for treating migraine attacks and may reduce public and personal disadvantages for people with migraine [24,25].…”