Naratriptan in the short-term prophylaxis of pure menstrual migraine

Abstract

Menstrual migraines are particularly difficult-totreat. Few studies on the use of triptans in short-term prophylaxis of menstrually related migraine have been recently conducted, but evidences of triptans' efficacy in the specific case of pure menstrual migraine (PMM) are lacking. The aim of this study is to explore the efficacy and tolerability of naratriptan as short-term prophylaxis of pure menstrual migraine (PMM) attacks. A multi-centre, open, non comparative, pilot six-month study was conducted in women, aged 18 years or older, with regular menstrual cycles and with a history of migraine without aura exclusively associated to the perimenstrual period. After an observation period of three months, patients took for three consecutive menstrual cycles oral naratriptan 1 mg twice daily, starting two days before the expected onset of menstruation and continuing for six days. Ninety-eight women with a history of PMM were screened for study participation, and 61 entered the study. Fifty-nine comprised the intent-to-treat population. The mean number of PMM attacks decreased from 3.5+/-1.4 in the 3-month observation period to 1.6+/-1.3 in the 3-month treatment with naratriptan. The pecentage of responders (subjects who recorded a decrease-equal or more than 50%-in the mean number of attacks) was 61.4%. A tendency towards a decrease in headache severity and in the presence of associated symptoms was observed during treatment. At least one adverse event during the treatment period was reported by 19 patients (31.1%). No serious adverse events occurred. Naratriptan may be an effective and safe treatment option in the short-prophylaxis of PMM.

Frovatriptan vs. transdermal oestrogens or naproxen sodium for the prophylaxis of menstrual migraine

“…However, this is the first study comparing these three treatments in women with MM. As this condition is often more severe than other types of migraine and its response to acute treatment is often less favourable than for other forms of migraine [7][8][9][10], our study results strengthen the usefulness of short-term prevention of this condition with triptans, previously reported by open-label and double-blind controlled studies [11][12][13][14]. The relatively similar effect of frovatriptan f f and transdermal oestrogens on severity of headache attacks in the subgroup of women with true MM, and the hypothesised possible interaction between serotonin synthesis and oestrogen [24] in the genesis of MM, also suggests a potential benefit in the combination of these two drugs for prophylaxis of this subtype of MM.…”

“…Data are shown for the two days preceding (-2 and -1) and the 3 days following menses (1, 2 and 3), and for the day when bleeding started (0). p refers to interaction between treatment and time cy of migraine attacks by nearly two over the course of 3 months as compared to placebo [14]. In a double-blind study 2.5 mg of naratriptan 2 times per day, but not 1 mg, was effective in reducing the incidence of headache [12].…”

“…In this case perimenstrual prophylaxis with naproxen sodium, oestradiol supplementation or triptans has been shown to be effective f f in decreasing attack frequency and severity [9][10][11][12][13][14]. Among the various triptans effectively employed in MM, frova f f -triptan is a second-generation triptan showing high selectivity for cerebral vasculature, long elimination half-life and high persistence of therapeutic action and may ensure an effective preventive treatment of MM [1 f f 1,15], with a better safety profile than other triptans [16].…”

A review of the use of frovatriptan in the treatment of menstrually related migraine

“…Evidence of triptan efficacy for short-term prophylaxis is consistent only for naratriptan [Mannix et al 2007;Moschiano et al 2005;Newman et al 2001;Brandes et al 2007], and frovatriptan Brandes et al 2009;Guidotti et al 2007], while it is limited for sumatriptan [Newman et al 1998], and zolmitriptan [Tuchman et al 2006[Tuchman et al , 2008, and lacking for other triptans.…”

Review: Menstrual migraine: therapeutic approaches

“…Triptans Trials using frovatriptan, naratriptan, sumatriptan and zolmitriptan for perimenstrual prophylaxis have suggested efficacy [Tuchman et al 2008;Moschiano et al 2005;Silberstein et al 2004;Newman et al 2001Newman et al , 1998]. …”