Treatment of Perimenstrual Migraine with Triptans: an Update

Casolla, Barbara; Lionetto, Luana; Candela, Serena; D'Alonzo, Lidia; Negro, Andrea; Simmaco, Maurizio; Martelletti, Paolo

doi:10.1007/s11916-012-0280-0

Cited by 18 publications

(11 citation statements)

References 51 publications

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“…Clinical studies also show the possibility of a short-term prevention of perimenstrual migraine with triptans or hormonal treatment [7, 8]. Recently, non-invasive vagus nerve stimulation has been suggested as prophylactic treatment for menstrual (related) migraine [9].…”

Section: Introductionmentioning

confidence: 99%

Treatment of menstrual migraine; multidisciplinary or mono-disciplinary approach

2017

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BackgroundThe aim of this study was to compare a multidisciplinary approach of menstrual (related) migraine, combining the neurological and gynaecological consultation, to a mono-disciplinary approach involving neurological treatment.There is a clear relationship between the menstruation cycle and the occurrence of migraine (menstrual migraine). Nowadays the treatment of menstrual (related) migraine is performed by a neurologist. A treatment with attention to hormonal treatment seems more convenient.MethodsThis retrospective study was performed in a cohort using data of 88 women with menstrual (related) migraine who visited the menstrual migraine clinic between 2012 and 2014 (intervention group). The results were compared to a historical control group, which consisted of women with menstrual (related) migraine who were treated before 2012 and received a mono-disciplinary approach.ResultsIn the intervention group the Headache Impact (HIT) score significantly improved (65 to 59 points). The mean headache days per month declined significantly (from 6 to 3.83 days) and these women needed less use of pain medication. In the control group the decline in HIT score was less striking (65 to 63.5 points) and the mean headache days per month increased (6 to 6,5 days). It appeared that 20 out of 27 patients in the control group required a gynaecological consultation in course of time.ConclusionA multidisicplinary treatment of women with menstrual (related) migraine gives better results compared to a mono-disciplinary approach. These results should be interpreted with caution as we performed a retrospective study with a relative small control group.

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Section: Introductionmentioning

confidence: 99%

Treatment of menstrual migraine; multidisciplinary or mono-disciplinary approach

2017

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“…Although all triptans have the same mechanism of action and simple and consistent pharmacokinetic features, there are specific differences among individual agents that may account for their different clinical attributes. For instance, in the treatment of perimenstrual migraines, which are known to be particularly severe and disabling, the different triptans showed different profiles of efficacy, either given for acute attacks or for short-term prophylaxis [35]. In the patient preference head to head comparative trials, the drugs showed similar efficacy in the short-term, in particular at 2 hours, but frovatriptan provided a more sustained response, with a lower recurrence rate, likely related to its much longer elimination half-life [6].…”

Section: Discussionmentioning

confidence: 99%

Frovatriptan and Rizatriptan Economic EVAluation: the FREEVA study

Lisotto¹,

Guidotti

Zava

et al. 2013

J Headache Pain

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BackgroundThe present pharmacoeconomic study compared the direct and indirect costs of using frovatriptan versus rizatriptan in the acute treatment of migraine.MethodsData on the cost-efficacy of the two triptans were derived from a recently published Italian, multicenter, randomized, double-blind, cross-over patient preference study, comparing frovatriptan versus rizatriptan. The direct costs were obtained by calculating the drug consumption, both of triptans and rescue medications. Prices of currently marketed drugs were obtained from Italian Drug Agency price list. The indirect costs were those related to absenteeism from the workplace due to migraine.Results129 of the 148 patients with a current history of migraine randomized to the two study drugs and completing the study were analyzed. The number of attacks treated with only 1 dose of study drug was higher with frovatriptan (157 vs. 147), whereas the number of attacks treated with ≥2 doses of study medication was higher with rizatriptan (122 vs. 110 and 74 vs. 67, respectively). However, more patients treated with frovatriptan took a rescue medication (71 vs. 59). The total direct cost per attack (including study drug rescue medication) was 9.12 € for frovatriptan and 13.54 € for rizatriptan (p < 0.05 between-treatments). As for indirect costs, in the group of patients treated with frovatriptan the mean number of lost working hours was significantly (p < 0.05) lower (1.5 h) compared to the subjects who used rizatriptan (2.8 h). Based on the earned income per unit of work, indirect costs per attack resulted to be 24.55 € for frovatriptan and 45.84 € for rizatriptan. Overall, the total costs, including direct and indirect costs, were evaluated to be 33.67 € for frovatriptan and 59.38 € for rizatriptan, respectively.ConclusionsWithin the limitations of this model analysis, frovatriptan was found to be significantly more cost-effective than rizatriptan. This outcome can be explained by the lower acquisition cost of frovatriptan, the need for fewer doses, and the loss of fewer working hours. This finding could drive selection of the most appropriate oral treatment for acute migraine attacks based on both individual patient’s needs and the cost-effectiveness of the available drugs.Trial registration2006-002572-17 (EudraCT).

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“…A reasoned guide useful to deal with pure MM should foresee the use of daily triptans during the bleeding phase for at least 3 days [8,9]. In case of migraine with MM days this approach is not useful as it could expose the patient to a situation of acute overuse, which occurs when the 10 days/month is reached with triptans single use or combined with NSAIDs.…”

Section: Bodymentioning

confidence: 99%