UPDATES IN MIGRAINE THERAPY

Neurological Sciences

, Volume 26, Supplement 2, pp s108-s110

First online:

Early triptan intervention in migraine: an overview

  • F. MoschianoAffiliated withL. Mandic Hospital
  • , D. D’AmicoAffiliated withDepartment of Neuroscience Clinics, C. Besta National Neurological Institute
  • , G. AllaisAffiliated withWoman’s Headache Centre, Department of Gynaecology and Obstetrics, University of Turin
  • , A. RigamontiAffiliated withDepartment of Neuroscience Clinics, C. Besta National Neurological Institute
  • , P. MelziAffiliated withL. Mandic Hospital
  • , F. SchieroniAffiliated withL. Mandic Hospital
  • , G. BussoneAffiliated withDepartment of Neuroscience Clinics, C. Besta National Neurological Institute Email author 

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Abstract

Although triptans are highly effective for the acute treatment of migraine, sustained pain-free rates—considered the optimal end-point—are in the range of 18%–27% for all triptans in clinical trials. A recently proposed strategy for treating migraine attacks is that triptans should be given early, when the pain is mild, rather than moderate or severe. Studies with different triptans have shown that early intervention can result in higher pain-free rates, together with reductions in rescue medication use and recurrence rates. However these studies suffer from methodological pitfalls: most were retrospective analyses of trials not designed to evaluate the benefit of early intervention; the definition of “early” differed from study to study; and placebo effects were not correctly evaluated. Furthermore, the disadvantages of this strategy in clinical practice, particularly the risk of medication overuse, have not been evaluated. We propose that only patients with particularly severe migraines and in whom attacks are always characterised by rapid progression of pain and other symptoms, should be advised to take a triptan as early as possible.

Key words

Triptans Migraine Early intervention