Triptans vs Other Drugs for Acute Migraine. Are There Differences in Efficacy? A Comment

Tfelt‐Hansen, Peer

doi:10.1111/j.1526-4610.2008.01064.x

Cited by 36 publications

(28 citation statements)

References 33 publications

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“…In these situations, Triptans: low utilization and high turnover 5 patients prefer other medications such as OTC drugs or NSAIDs. Although triptans are undoubtedly very efficacious for migraine attacks, a clear superiority over NSAIDs in comparative studies did not appear on the primary end-point (8,30,31). A recent study has also reported a superiority of an OTC drug in comparison with sumatriptan (32).…”

Section: Discussionmentioning

confidence: 98%

Triptans: Low utilization and high turnover in the general population

et al. 2009

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Studies performed in selected populations have shown a poor utilization of triptans for migraine. Our study was aimed at establishing patterns of triptans utilization in a large community using the pharmaceutical prescriptions database of two consecutive years in a regional Health Authority in Italy. About 0.5% of the population observed received triptans prescriptions in a year, but > 50% of the cases received only one prescription. On the other hand, 46% of triptan users did not receive a triptan prescription in the following year (past users): in 80% of cases, patients received only 1-2 triptan packages. The evaluation of the discontinued triptan type has shown percentages varying between 30 and 70%. The percentage of triptan users who received a triptan prescription for the first time in the successive year of study (new users) was 52%. These findings together highlight a high turnover in triptans utilization. Less than 15% of subjects received more than one triptan product in the 2 years. In conclusion, we observed a low percentage of triptan users and a low rate of utilization, associated with a high percentage of discontinuation and new utilization (high turnover), without any substantial increase in triptans utilization during the years. All these data probably do not support optimal satisfaction with triptan therapy.

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Section: Discussionmentioning

confidence: 98%

Triptans: Low utilization and high turnover in the general population

et al. 2009

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“…We focused on inflammatory genes because anti-inflammatory drugs are effective in treating migraine 21, 22 , and in mildly delaying the progression from episodic to chronic headaches 23, 24 . We focused on the calvarial periosteum because it is the tissue to which pericranial and neck muscles are inserted to, because muscle neck aches can originate in their tendons 25, 26 , and because it is commonly included in the perception of imploding headache.…”

Section: Introductionmentioning

confidence: 99%

Upregulation of inflammatory gene transcripts in periosteum of chronic migraineurs: Implications for extracranial origin of headache

Perry

Blake

Buettner

et al. 2016

Annals of Neurology

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Objective Chronic migraine (CM) is often associated with chronic tenderness of pericranial muscles. In fact, a distinct increase in muscle tenderness prior to onset of occipital headache that eventually progresses into a full blown migraine attack is common. This experience raises the possibility that some CM attacks originate outside the cranium. The objective of this study was to determine whether there are extracranial pathophysiologies in these headaches. Methods We biopsied and measured the expression of gene transcripts (mRNA) encoding proteins that play roles in immune and inflammatory responses in affected (i.e., where the head hurts) calvarial periosteum of (a) patients whose CMs are associated with muscle tenderness and (b) patients with no history of headache. Results Expression of proinflammatory genes (e.g., CCL8, TLR2) in the calvarial periosteum significantly increases in CM patients attesting to muscle tenderness, whereas expression of genes that suppress inflammation and immune cell differentiation (e.g., IL10RA, CSF1R) decreased. Interpretation Because the up-regulated genes were linked to activation of white blood cells, production of cytokines, and inhibition of NFKB, and the down-regulated genes linked to prevention of macrophage activation and cell lysis, we suggest that the molecular environment surrounding periosteal pain fibers is inflamed and in turn activates trigeminovascular nociceptors that reach the affected periosteum through suture branches of intracranial meningeal nociceptors and/or somatic branches of the occipital nerve. This study provides the first set of evidence for localized extracranial pathophysiology in chronic migraine.

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“…In contrast, in a systematic review of triptans [3n] the mean therapeutic gain (active minus placebo) for headache relief at 2 h was 19% (95% CI 16–22%) for frovatriptan 2.5 mg, whereas it was 33% (95% CI 31–35%) for sumatriptan 100 mg, 34% (95% CI 30–37%) for zolmitriptan 2.5 mg, 36% (95% CI 32–39%) for rizatriptan 10 mg, and 27% (95% CI 20–33%) for almotriptan 12.5 mg. The superiority of sumatriptan 100 mg versus frovatriptan 2.5 mg was confirmed in a not fully published large ( n = 1196) RCT in which the headache relief rates were 47 and 37%, respectively [4, 5]. The recurrences rates for frovatriptan (25%) and sumatriptan (31%) were similar.…”

mentioning

confidence: 84%

When to use frovatriptan in migraine?

Tfelt‐Hansen

2011

J Headache Pain

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Triptans vs Other Drugs for Acute Migraine. Are There Differences in Efficacy? A Comment

Cited by 36 publications

References 33 publications

Triptans: Low utilization and high turnover in the general population

Triptans: Low utilization and high turnover in the general population

Upregulation of inflammatory gene transcripts in periosteum of chronic migraineurs: Implications for extracranial origin of headache

When to use frovatriptan in migraine?

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