Frovatriptan vs. other triptans for the acute treatment of oral contraceptive-induced menstrual migraine: pooled analysis of three double-blind, randomized, crossover, multicenter studies

Allais, Gianni; Tullo, V.; Omboni, Stefano; Pezzola, D; Zava, Dario; Benedetto, Chiara; Bussone, Gennaro

doi:10.1007/s10072-013-1393-x

Cited by 11 publications

(11 citation statements)

References 20 publications

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“…Moreover, this result could be explained by the very early intake of medication, during migraine premonitory phase, due to the consistent predictability of attacks [13]. Interestingly, these data found in the subgroup of subjects treating migraine attacks occurring on weekends, are in line with those observed in the main study population [28] and in the subgroups of women with menstrual migraine [22] and with oral contraceptiveinduced menstrual migraine [29].…”

Section: Discussionsupporting

confidence: 81%

Efficacy of Frovatriptan vs. Other Triptans in Weekend Migraine: Pooled Analysis of Three Double-Blind, Randomized, Crossover, Multicenter Studies

Lisotto¹

2014

Brain Disord Ther

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Background: Migraine attacks usually occur at any time, in particular either during days off or workdays. Limited evidence is available on the efficacy of antimigraine drugs in patients whose attacks occur on weekends. Objective: To evaluate the efficacy of four different triptans in weekend vs. workday migraine attacks through a pooled analysis of individual data of three randomized, double-blind, crossover studies. Methods: Subjects with a history of migraine with or without aura were randomized to frovatriptan 2.5 mg or rizatriptan 10 mg (study 1), frovatriptan 2.5 mg or zolmitriptan 2.5 mg (study 2), frovatriptan 2.5 mg or almotriptan 12.5 mg (study 3). Each patient was requested to treat up to 3 attacks with each drug during both 3 month periods, as established by the crossover trial protocol. In this retrospective analysis the migraine attacks occurring on workdays were differentiated from those occurring on weekends. The efficacy of the drugs during weekends and workdays was compared. Results: Of the 346 intention-to-treat population patients, 188 (54%) had migraine attacks also on weekends. Overall, a total of 569 attacks occurred during weekends and 1,281 during workdays. Proportion of pain-free at 2 hours did not significantly differ between weekend and workday attacks for frovatriptan (26% vs. 27%) as well as for comparators (34% vs. 32%). Headache relief episodes were also similarly represented between weekend and nonweekend attacks (frovatriptan: 40% vs. 42% and comparators: 49% vs. 43%, p=NS). Conversely, the relapse rate within 48 hours for weekend attacks compared to workday attacks was significantly lower with frovatriptan (17% vs. 30%, p<0.05), while this finding was not observed for comparators (weekends 34% vs. workdays 40%, p=NS). Conclusions: Our study provides the first evidence that frovatriptan represents a particularly favorable option for treating weekend migraine attacks.

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Section: Discussionsupporting

confidence: 81%

Efficacy of Frovatriptan vs. Other Triptans in Weekend Migraine: Pooled Analysis of Three Double-Blind, Randomized, Crossover, Multicenter Studies

Lisotto¹

2014

Brain Disord Ther

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“…Although any triptan can be used for MM on an asneeded basis, published data for acute treatment in MM are available on frovatriptan 2.5 mg, 41 almotriptan 12.5 mg, 42,43 naratriptan 2.5 mg, 44 sumatriptan 6 mg injectable, 45 sumatriptan 50 and 100 mg tablets (with the 100 mg tablet showing a slight trend in better efficacy than the 50 mg dose in one study), 46-48 rizatriptan 10 mg, 49,50 and zolmitriptan 2.5 mg and 5 mg. 51,52 Although frovatriptan has been shown to be as effective as almotriptan and zolmitriptan, there appears to be a lower rate of recurrence with frovatriptan due to its long half-life and duration of action, making it a particularly appealing choice for MM. 53,54 A variety of NSAIDs can be used in the treatment of MM. Since elevated prostaglandins have been observed in women with MM 30 use of NSAIDs, which interfere with the production of PGs and other inflammatory molecules seen in the pathophysiology of migraine, seems to make sense, and some data support their use for "miniprophylaxis" (see below).…”

Section: Treatment Of Menstrual Migrainementioning

confidence: 99%

Migraine in Women

2017

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Migraine is one of the most common neurological disorders, affecting women disproportionally at a rate of 3:1. Prior to puberty, boys and girls are equally affected, but the female preponderance emerges after puberty. Migraine pathophysiology is not fully understood, and although the hormonal effect of estrogen is significant, other factors are at play. This article will focus on the hormonal influence on migraine in women. Here we review our most recent understanding of migraine and menstrual migraine, including epidemiology, pathophysiology, and treatment strategies for this challenging disorder, as well as migraine during pregnancy, postpartum period, breastfeeding, perimenopause, and menopause. We also review the risks and benefits of exogenous hormone use in this population and discuss stroke risk in women with migraine aura. By understanding these aspects of migraine in women, we hope to arm practitioners with the knowledge and tools to help guide treatment of this debilitating disorder in this large population.

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“…In the subgroup analysis of OCMM, the mean age of women with OCMM was 35±9 years compared with 34±7 years for women with non-OCMM 69. There were no statistically significant differences between frovatriptan and comparator triptans for pain relief at 2 and 24 hours, and for pain-free response at 2 hours; significantly more women treated with frovatriptan were pain-free at 24 hours and had lower relapse rates at 24 and 48 hours (Table 2).…”

Section: Frovatriptan For the Acute Treatment Of Menstrual Migrainementioning

confidence: 94%

A review of frovatriptan for the treatment of menstrual migraine

MacGregor¹

2014

IJWH

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The objective of this review is to provide an overview of menstrual migraine (MM) and of frovatriptan and to assess clinical trial data regarding the efficacy and safety of frovatriptan for the acute and short-term prophylaxis of MM. Randomized controlled trials comparing frovatriptan with placebo or a triptan comparator for the acute or prophylactic treatment of MM were selected for review. MM affects up to 60% of women with migraine. Compared with attacks at other times of the cycle, menstrual attacks are longer, more severe, less responsive to treatment, more likely to relapse, and more disabling than attacks at other times of the cycle. No drugs are licensed for acute treatment of MM; triptans are recommended for treatment of moderate to severe attacks for menstrual and nonmenstrual attacks. Perimenstrual prophylaxis is indicated for patients with predictable MM that does not respond to symptomatic treatment alone. Treatment is unlicensed, but options include triptans, nonsteroidal anti-inflammatory drugs, and hormone manipulation. Frovatriptan is distinctive from other triptans due to its long elimination half-life of 26 hours, which confers a longer duration of action. Post hoc analyses from randomized trials of MM show similar pain relief and pain-free rates for frovatriptan compared with other triptans (2 hours pain-free: relative risk [RR] 1.27, 95% confidence interval [CI] 0.91–1.76) but significantly lower relapse rates (24 hours sustained pain-free: RR 0.34, 95% CI 0.18–0.62). Data from randomized controlled trials show a significant reduction in risk of MM in women using frovatriptan 2.5 mg once daily (RR 1.56, 95% CI 1.31–1.86) or twice daily (RR 1.98, 95% CI 1.68–2.34) for perimenstrual prophylaxis compared with placebo. The twice daily dosing was more effective than once daily (RR 1.27, 95% CI 1.11–1.46). These findings support the use of frovatriptan as a first-line acute treatment for MM and for perimenstrual prophylaxis.

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Frovatriptan vs. other triptans for the acute treatment of oral contraceptive-induced menstrual migraine: pooled analysis of three double-blind, randomized, crossover, multicenter studies

Cited by 11 publications

References 20 publications

Efficacy of Frovatriptan vs. Other Triptans in Weekend Migraine: Pooled Analysis of Three Double-Blind, Randomized, Crossover, Multicenter Studies

Efficacy of Frovatriptan vs. Other Triptans in Weekend Migraine: Pooled Analysis of Three Double-Blind, Randomized, Crossover, Multicenter Studies

Migraine in Women

A review of frovatriptan for the treatment of menstrual migraine

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