Sumatriptan for the Range of Headaches in Migraine Sufferers: Results of the Spectrum Study

Abstract

Background.-Migraineurs experience a spectrum of headaches: migraine, migrainous, and episodic tensiontype as defined by the International Headache Society (IHS).Objective.-To evaluate the effectiveness of sumatriptan, 50-mg tablets, in treating the spectrum of headaches in IHS-diagnosed migraineurs.Design/Methods.-Migraineurs with severe disability (Headache Impact Questionnaire score 250 or greater) were enrolled in a randomized, double-blind, placebo-controlled, crossover study. Patients treated up to 10 headaches with sumatriptan, 50 mg, or placebo (4:1). Headache features, recorded prior to treatment, were used to classify each headache using IHS criteria. Headache response (moderate or severe pain reduced to mild or no pain) and pain-free response were recorded at 2 and 4 hours postdose (primary endpoint). Because patients treated multiple attacks, statistical methods controlling for within-subject correlation were used.Results.-Two hundred forty-nine migraineurs treated 1576 moderate or severe headaches: migraine (n ϭ 1110), migrainous (n ϭ 103), and tension-type (n ϭ 363). Sumatriptan was superior to placebo for headache response 4 hours postdose (primary endpoint) across all headache types (migraine, 66% versus 48%; P Ͻ .001; migrainous, 71% versus 39%; P Ͻ .01; tension-type, 78% versus 50%, P Ͻ .001). Sumatriptan was also superior to placebo for pain-free response 4 hours postdose for migraine (41% versus 24%, P Ͻ .001) and tension-type headaches (56% versus 36%, P ϭ .001). Sumatriptan provided superior pain-free response 2 hours postdose for migraine (18% versus 7%, P Ͻ .0001) and tension-type headache (28% versus 14%, P ϭ .0005) compared with placebo.Conclusion.-Sumatriptan, 50-mg tablets, are effective for the full spectrum of headaches experienced by patients with disabling migraine due to a sumatriptan-responsive mechanism.

Patient satisfaction with a neurological specialist consultation for headache

“…Investigating the use of analgesics is important if we are to understand and correctly treat patients with chronic daily headache. Evidence suggests that patients with combined migraine and TTH (mixed headache) may experience relief of both headache syndromes by treatment with triptans (19). A relatively low rate of patient satisfaction in the subgroup of mixed headache patients found in this study may suggest that these patients were wrongly classi ed, or that they received suboptimal treatment from the specialist.…”

Managing migraine headaches experienced by patients who self–report with menstrually related migraine: a prospective, placebo–controlled study with oral sumatriptan

“…The present study demonstrated the efficacy of oral sumatriptan (100 mg) for the spectrum of migraine attacks in a population of patients self-reporting with menstrually related migraine. To support this, recent studies have shown that oral sumatriptan (50 mg) is an effective treatment for the spectrum of headaches reported by the general population of migraine sufferers [26].…”

“…Secondly, recent studies have demonstrated that severely affected migraine sufferers have multiple clinical presentations of their migraine attacks, from true migraine, through migrainous headache to tension-type headache. However, this entire spectrum of headache may be a manifestation of the migraine process [26].…”

Strategies of care for acute treatment of migraine

“…Using post-hoc analysis, Cady and colleagues [20] studied both the Spectrum study [21,23] and the M09 study authored by Pfaffenrath et al [22] to examine the results for patients who violated the clinical protocol and treated acute attacks with either sumatriptan or placebo at mild level pain, rather than waiting for moderate to severe level pain. Both studies offered placebo-controlled, albeit non-randomized groups of patients to compare the outcomes of treating mild versus moderate to severe level pain for sustained pain-free response [20][21][22][23].…”

“…Both studies offered placebo-controlled, albeit non-randomized groups of patients to compare the outcomes of treating mild versus moderate to severe level pain for sustained pain-free response [20][21][22][23].…”