Clinical efficacy of rizatriptan for patients with migraine: efficacy of drug therapy for migraine accompanied by tension headache–like symptoms, focusing on neck stiffness

Abstract

According to an epidemiological study in Japan, there are as many as 22 million patients with tension headache and 8.4 million with migraine. Furthermore, patients suffering from both types of headache concurrently are estimated to account for more than 50% of headache patients. We studied the efficacy of drug therapy for migraine accompanied by tension headache-like symptoms, focusing principally on neck stiffness. We evaluated the efficacy of rizatriptan by comparison of findings before and after therapy in 34 migraine patients, consisting of 16 without neck stiffness (migraine without neck factor: WONF) and 18 with it (migraine with neck factor: WNF), who received treatment at our neurology/internal medicine department from 1 March 2004 to 31 May 2005. In the study, all the patients were asked to keep a record of their migraine status. The severity of migraine was classified by physicians according to the International Headache Society diagnostic criteria, based on which drug efficacy was evaluated. We selected rizatriptan for migraine treatment in our study based on Dr. Ferrari's report. In the efficacy study of rizatriptan, in the group of 34 migraine patients, the pain relief rate (79.4%) and pain-free rate (41.2%) at two hours after treatment were as high as those reported in the meta-analysis performed by Ferrari et al., indicating high efficacy of rizatriptan. In the efficacy comparison between the WONF and WNF groups, the painfree rates were 56.3% and 27.8%, and cumulative pain relief rates were 100% and 61.1%, respectively, with better results in the WONF group. A test result was also significantly better (p=0.0076) in the WONF group. Rizatriptan was proved effective in treating migraine patients accompanied by tension headachelike symptoms. Comparison of efficacy rates between patient groups with and without tension headache-like symptoms showed that the pain relief rate in the group without neck stiffness was higher.

Dura-evoked neck muscle activity involves purinergic and N-methyl-D-aspartate receptor mechanisms

“…It is also noteworthy that the current study has shown the involvement of purinergic receptor mechanisms specifically in duraevoked neck muscle activity, consistent with previous findings of P2X receptors in the dura and MDH [10,11, 21], and, as noted above, of the involvement of MDH as an interneuronal site in trigeminally evoked neck muscle reflex pathways [1]. Thus, it is also possible that P2X receptor mechanisms in the dura and MDH may play an important role in neck stiffness, which is a common symptom of migraine and other types of headaches [18–20]. …”

“…application to the medulla of TNPATP or the NMDA receptor antagonist APV can also block the increase in neck muscle EMG activity evoked by α,β-meATP application to the dura. Since ATP and glutamate are associated with some headache conditions [2–4] and neck muscle stiffness has been reported to occur with dura inflammation in migraine headache [18], tension-type headache [19] and meningitis [20], these novel findings suggest that some headache conditions may involve afferent inputs into the central nervous system that utilize dural purinergic processes and that are modulated by medullary purinergic and NMDA receptor mechanisms.…”

A review of the 5-HT1B/1D agonist rizatriptan: update on recent research and implications for the future

“…As expected by the investigators, rizatriptan provided good efficacy in the general study population (79.4% pain relief and 41.2% pain-free at 2 h). Pain relief in patients without neck stiffness (56.3% pain free at 2 h) was superior to that in patients who had neck stiffness (27.8% pain free at 2 h) and patient satisfaction was also observed as better in patients who did not have neck stiffness [45] .…”

“…It has been estimated that > 50% of headache patients experience both migraine and tension headache [45,46] . Sumatriptan has been shown in some studies to be effective in alleviating both migraine and tension-like headache features; in a recent study among patients with self-reported tension headache who met criteria for migraine, sumatriptan did not differ from placebo in terms of pain relief at 2 h but provided effective relief at 4 h and sustained relief at 24 h [46] .…”

“…Sumatriptan has been shown in some studies to be effective in alleviating both migraine and tension-like headache features; in a recent study among patients with self-reported tension headache who met criteria for migraine, sumatriptan did not differ from placebo in terms of pain relief at 2 h but provided effective relief at 4 h and sustained relief at 24 h [46] . An open-label assessment was recently conducted evaluating rizatriptan for the treatment of migraine with the tension headache-like symptom of neck stiffness to characterize the effect of rizatriptan against this particular headache symptom [45] . Variability among patients for timing of self-medication was noted, with a mean time of ∼ 5.5 h after the onset of pain.…”