Almotriptan 12.5 mg in menstrually related migraine: A randomized, double-blind, placebo-controlled study

Abstract

Background: Menstrually related migraine (MRM) affects more than half of female migraineurs. Because such migraines are often predictable, they provide a suitable target for treatment in the mild pain phase. The present study was designed to provide prospective data on the efficacy of almotriptan for treatment of MRM.Methods: Premenopausal women with MRM were randomized to almotriptan (N = 74) or placebo (N = 73), taken at onset of the first perimenstrual migraine. Patients crossed over to the other treatment for the first perimenstrual migraine of their second cycle, followed by a two-month open-label almotriptan treatment period.Results: Significantly more patients were pain-free at two hours (risk ratio [RR] = 1.81; p = .0008), pain-free from 2–24 hours with no rescue medication (RR = 1.99; p = .0022), and pain-free from 2–24 hours with no rescue medication or adverse events (RR = 1.94; p = .0061) with almotriptan versus placebo. Nausea (p = .0007) and photophobia (p = .0083) at two hours were significantly less frequent with almotriptan. Almotriptan efficacy was consistent between three attacks, with 56.2% of patients pain-free at two hours at least twice. Adverse events were similar with almotriptan and placebo.Conclusion: Almotriptan was significantly more effective than placebo in women with MRM attacks, with consistent efficacy in longer-term follow-up.

Treatment of migraine: update on new therapies

“…Telcagepant 140 and 280 mg were superior to placebo with pain freedom and relief rates at 2 h similar to those computed in the survey by TfeltHansen [3 ] (average values calculated over four attacks: 23.65 and 55.65% with 140 mg, 27.75 and 58.6% with 280 mg, compared to 12.3 and 35.15% with placebo); 2-24 h pain freedom was also superior: 15.53% for telcagepant 140 mg, 19.35% for 280 mg and 7.93% for placebo. The percentage of patients with 2-h pain freedom and 2-h pain relief consistency was significantly higher for both telcagepant doses vs. control.…”

“…Menstrual migraine attacks can be difficult to manage. Almotriptan 12.5 mg was found effective for their treatment, producing a 48.4% 2-h-pain-free rate and 2-24-h-sustained pain-free in most patients [19]. In the START study [20], 1174 migraine attacks were treated with almotriptan 12.5 mg within 1 h of pain onset and when pain was mild.…”

Almotriptan for menstrually related migraine

“…The triptans tested most often for the acute treatment of menstrual migraine in specific trials are sumatriptan [35][36][37][38][39][40][41][42], rizatriptan [30,[43][44][45][46][47][48][49], zolmitriptan [50][51][52] and, most recently, almotriptan (Box 1) [31, [53][54][55].…”

“…Four studies specifically addressed to assess the efficacy of almotriptan in the treatment of menstrual migraine [31, [53][54][55] are present in the medical literature. Two of them report post hoc analyses of data derived from larger studies on the use of almotriptan for acute migraine treatment.…”

Triptans: over the migraine

“…Evidence of efficacy with acceptable safety and tolerability exists between triptans for sumatriptan 50 and 100 mg, rizatriptan 10 mg, combination of sumatriptan/naproxen 85 mg/500 mg, and as short term prophylaxis for frovatriptan and naratriptan [2]. Almotriptan demonstrated to be significantly more effective than placebo in women with menstrual related migraine attacks, with consistent efficacy in long-term follow-up [3]. In addition to migraine attacks, triptans are also sometimes helpful for other primary headaches such as cluster headaches (CH) [4].…”