Headache recurrence and treatment

Abstract

The definition of recurrence includes the following: any headache occurring after a headache-free state at 2 hours and within 24 hours after intake of drug; a headache that has never been studied systematically; a headache that may not be an outcome of drug treatment; a headache that may be due to the inherent nature of migraine and individual patient characteristics such as duration of attack; and headache for which effective treatment may be a re-dose of the initial medication or addition of steroidal or nonsteroidal anti-inflammatory medications.

Why pharmacokinetic differences among oral triptans have little clinical importance: a comment

“…The comparison among different studies is not possible, for an endless number of methodological problems (e.g., differences in the study design, the populations used, the characteristics of the attacks, the doses administered, the definition of recurrence, relapse or return, the methods of registration of recurrence, and the presence of recurrence also after the administration of placebo) [12, 49, 51]. Consequently, any result can be interpreted for or against any medication.…”

“…Furthermore, less than 2/3 of patients respond to a triptan in three out of three attacks [11]. Recurrence is a common event; in triptan trials, recurrence rates vary from 7 to 57% [12], and in patients using triptans headache return is associated to 24% of headaches which have had a pain-free response [13]. Indeed, 40–50% of patients report dissatisfaction with at least one aspect of their current triptan therapy [14], there is a marked variation in the individual patient response and preference for the available oral triptans [15, 16], and it seems that there are no characteristics which can make the difference between one drug and another [17].…”

Variability in recurrence rates with acute treatments for migraine: why recurrence is not an appropriate outcome measure

“…For this review, we chose to highlight key studies that focused specifically on the evaluation of recurrence rates. The trials used different methodologies for defining recurrence and, as noted, described recurrence with oral sumatriptan, the first approved agent in the triptan class and the most commonly prescribed, and frovatriptan, a second-generation triptan with a longer plasma half-life of 26 h, compared with 2.5 h for sumatriptan [ 9 , 13 , 25 , 26 ]. Of note, Ferrari and colleagues published several papers on the topic of recurrence, but we did not include their 1994 study on sumatriptan recurrence in our review, because that paper was an analysis of recurrence following a second dose of sumatriptan, not following the initial dose [ 27 ].…”

“…Triptans are a widely used and effective acute treatment for migraine; however, the studies discussed above highlight that these agents are often associated with high and variable recurrence rates [ 3 , 13 , 14 , 26 , 28 , 35 ]. The lack of uniformity with respect to how recurrence rates are defined is also evident when comparing different routes of administration of triptans.…”

“…Despite advances in migraine care, recurrence of migraine remains a major problem for patients and providers alike, which requires careful consideration when evaluating treatment efficacy in clinical trials [ 2 , 13 ]. Several factors may be associated with headache recurrence, including patient age, less-severe attacks (moderate vs severe migraine) or treatment at mild pain, duration of attack, slow drug-receptor dissociation, and characteristics of the patient and the particular attack [ 13 ]. Importantly, various definitions of recurrence have been used in the literature of clinical trials.…”