The treatment of migraine patients with triptans – is there a need for further Rx-to-OTC switches?

2019 ◽  
Vol 25 (01) ◽  
pp. 15-23 ◽  
Author(s):  
Anissa Schneider-Ziebe ◽  
Uwe May
Keyword(s):  
Migraine Attack ◽  
Online Survey ◽  
Access Point ◽  
Special Focus ◽  
German Population ◽  
Acute Migraine ◽  
Self Medication ◽  
Appropriate Treatment ◽  
Number Of Patients ◽  
Acute Migraine Attack

Abstract Objective The disease migraine affects a large share of the German population and is linked to a high economic potential in terms of direct and indirect sickness costs. Triptans are the recommended treatment in the case of an acute migraine attack. Both, the disease and its appropriate treatment are of interest in the context of self-medication and Rx-to-OTC switch efforts. Therefore, a survey was carried out with the intention to collect data among migraine patients regarding the use of analgesics in general and of triptans specifically. This data can be the basis for further health economic considerations. Methods By an online survey among 206 migraine patients, different data regarding patients suffering from migraine, the frequency and sort of symptoms and the use of analgesics in general as well as triptans specifically was collected and analysed. A special focus was on symptoms affecting patients’ productivity, their use of triptans and their satisfaction with the current supply situation with triptans. Results The survey revealed among other findings that most patients suffer from symptoms which limit their productivity or their ability to work and make an immediate treatment necessary. Most patients know well about their disease and feel able to treat themselves in the context of self-medication once they are diagnosed by a physician. In this context a demand for further triptans available without a prescription could be identified. This is specifically, because patients respond differently to various triptans. Therefore, a larger variety of prescription free triptans would increase the number of patients with access to OTC triptans significantly. Conclusion Most survey respondents know well about their disease and the appropriate treatment and feel able to treat themselves within the scope of self-medication. Nevertheless, they mostly respond to one triptan only. In the case of an acute migraine attack an immediate treatment is required, ideal is an intake of triptans as soon as first symptoms occur. In this context pharmacies play an important role as fast and low-threshold access point to medications. Because only a limited number of patients responds to the already prescription free available triptans, there is a demand for further Rx-to-OTC switches of triptans among migraine patients which should be considered in further switch efforts in Germany.

Treatment of Acute Migraine Attack With Diclofenac Sodium: A Double-Blind Study

1992 ◽  
Vol 32 (2) ◽  
pp. 98-100 ◽  
Author(s):  
George N. Karachalios ◽  
Adroniki Fotiadou ◽  
Nickolaos Chrisikos ◽  
Alexandros Karabetsos ◽  
Kyriakos Kehagioglou
Keyword(s):  
Migraine Attack ◽  
Diclofenac Sodium ◽  
Blind Study ◽  
Double Blind Study ◽  
Acute Migraine ◽  
Double Blind ◽  
Acute Migraine Attack

Differences of Anti-Nociceptive Mechanisms of Migraine Drugs on the Trigeminal Pain Processing during and Outside Acute Migraine Attacks

Cephalalgia ◽  
2004 ◽  
Vol 24 (8) ◽  
pp. 657-662 ◽  
Author(s):  
Z Katsarava ◽  
V Limmroth ◽  
O Baykal ◽  
D Akguen ◽  
H-C Diener ◽  
...  
Keyword(s):  
Migraine Attack ◽  
Healthy Subjects ◽  
Blink Reflex ◽  
Acute Attack ◽  
Pain Processing ◽  
Acute Migraine ◽  
Double Blind ◽  
Nociceptive Blink Reflex ◽  
Nociceptive Processing ◽  
Acute Migraine Attack

The aim of this study was to investigate central anti-nociceptive mechanisms of i.v. acetylsalicylic acid (ASA) and oral zolmitriptan (ZOL) in migraine patients and healthy subjects using the ‘nociceptive’ blink reflex (nBR). Twenty-eight migraine patients received ASA ( n = 14, 1000 mg i.v) or ZOL ( n = 14, 5 mg p.o) during the acute migraine attack and interictally. Thirty healthy subjects received either ASA or ZOL vs. placebo using a double blind cross over design. nBR was recorded in all patients and subjects before, 60 and 90 min after treatment. ASA and ZOL did not inhibit nBR responses in healthy subjects. Both ASA and ZOL suppressed nBR responses (ASA by 68%, ZOL by 78%) only during the acute attack but not interictally. The data suggest, that the anti-nociceptive effects of migraine drugs on the trigeminal nociceptive processing are different during and outside an acute migraine attack.

Treatment of Acute Migraine Attack: Naproxen and Placebo Compared

Cephalalgia ◽  
1985 ◽  
Vol 5 (2) ◽  
pp. 115-119 ◽  
Author(s):  
Knut Nestvold ◽  
Reidar Kloster ◽  
Markku Partinen ◽  
Raimo Sulkava
Keyword(s):  
Migraine Attack ◽  
Randomized Study ◽  
Treatment Preferences ◽  
Acute Migraine ◽  
Treatment Results ◽  
Double Blind ◽  
Head Pain ◽  
Main Complaint ◽  
Gastrointestinal Discomfort ◽  
Acute Migraine Attack

A double-blind, cross-over, randomized study of acute migraine attack compared treatment results of naproxen with that of placebo. Each treatment period continued for either three months or six migraine attacks, whichever occurred first. The initial dose of naproxen was 750 mg, with additional 250–500 mg doses taken if and when required, to a maximum of five 250 mg tablets within a period of 24 h in each migraine attack. Forty-one patients were enrolled in the study; they had all experienced at least two but not more than eight migraine attacks a month during the preceding year. Thirty-two patients completed the two treatment periods. Naproxen was statistically significantly superior to placebo in reducing the severity of head pain, nausea, and photophobia; in shortening the duration of head pain, nausea, vomiting, photophobia, and lightheadedness; in diminishing the frequency of vomiting; and in decreasing the need for escape medication. Both patient and physician treatment preferences significantly favoured naproxen. Nine side effects were experienced by seven patients while receiving placebo and seven by five patients during naproxen treatment. Mild gastrointestinal discomfort was the main complaint. Only one patient withdrew from treatment because of a side effect, which occurred while receiving placebo.

Treatment of the Acute Migraine Attack Current Status

Cephalalgia ◽  
1983 ◽  
Vol 3 (1) ◽  
pp. 61-67 ◽  
Author(s):  
Marcia Wilkinson
Keyword(s):  
Migraine Attack ◽  
Temporal Artery ◽  
Acute Attack ◽  
Current Status ◽  
Acute Migraine ◽  
Similar Action ◽  
Drug Treatments ◽  
Ergotamine Tartrate ◽  
Acute Migraine Attack ◽  
Gastrointestinal Activity

The main treatment of the acute migraine attack remains sleep, sedation, an anti-nauseant and analgesics, and in some patients 1 or 2 mg of ergotamine tartrate. Drugs containing large amounts of caffeine should not be used. Absorption of drugs may be impaired in a migraine attack. Metoclopramide is probably the anti-emetic of choice because it is an effective anti-nauseant and promotes normal gastrointestinal activity. Domperidone has a similar action but is said not to go through the blood-brain harrier, so is less likely to cause extrapyramidal reactions. All drugs, including analgesics such as aspirin and paracetamol, are best given in a soluble or effervescent form. Where vomiting occurs early in the attack, suppositories may be indicated. Ergotamine tartrate is necessary in about one third of attacks and is best given by suppository or by inhalation. Doses higher than 2 mg per attack or 6 mg in one week may cause toxic symptoms, the early signs of which are headache, nausea, vomiting and a feeling of not being very well. The non-drug treatments of an acute attack include pressing on the temporal artery, hot and cold compresses and relaxation.

Raised Plasma Endothelin During Acute Migraine Attack

Cephalalgia ◽  
1992 ◽  
Vol 12 (6) ◽  
pp. 383-384 ◽  
Author(s):  
Markus Färkkilä ◽  
Jorma Palo ◽  
Outi Saijonmaa ◽  
Frej Fyhrquist
Keyword(s):  
Migraine Attack ◽  
Normal Subjects ◽  
Cerebral Vessels ◽  
Acute Migraine ◽  
Initial Stage ◽  
The Mean ◽  
Potent Vasoconstrictor ◽  
Acute Migraine Attack

Endothelins are the most potent vasoconstrictor peptides known. Plasma endothelin (ET-1) concentrations were measured in eight migraine patients (mean age 44.5 years), two during an acute migraine attack with aura and six during an attack without aura. The mean ET-1 values were elevated in all migraine patients above the range of normal subjects, and were 10.6 (range 6.0–16.0) pg/ml in migraine patients and 3.8 (range 0.7–5.8) pg/ml in controls. We hypothesize that ET-1 may constrict cerebral vessels during the initial stage of the migraine attack.

scholarly journals Optimal dosing of lasmiditan in the management of acute migraine attack: A systematic review and meta-analysis

2021 ◽  
Vol 0 (0) ◽  
pp. 0
Author(s):  
Sivasankaran Ponnusankar ◽  
RoopaSatyanarayan Basutkar ◽  
ChrisElizabeth Vinod ◽  
ShruthiJaya Saju ◽  
Bhavya Chebrolu
Keyword(s):  
Systematic Review ◽  
Migraine Attack ◽  
Meta Analysis ◽  
Acute Migraine ◽  
Optimal Dosing ◽  
Acute Migraine Attack

Double-Blind Comparison of An Acetaminophen 400 mg-Codeine 25 mg Combination Versus Aspirin 1000 mg and Placebo in Acute Migraine Attack

Cephalalgia ◽  
1994 ◽  
Vol 14 (2) ◽  
pp. 156-161 ◽  
Author(s):  
F Boureau ◽  
JM Joubert ◽  
V Lasserre ◽  
B Prum ◽  
G Delecoeuillerie
Keyword(s):  
Clinical Trials ◽  
Migraine Attack ◽  
Evaluation Criteria ◽  
Complete Disappearance ◽  
Acute Migraine ◽  
Double Blind ◽  
Significant Difference ◽  
The Difference ◽  
Blind Comparison ◽  
Acute Migraine Attack

The purpose of this study was to compare the efficacy and tolerance of a single dose of the acetaminophen 400 mg-codeine 25 mg combination (ACC) aspirin 1000 mg (A) and a placebo (P) for the treatment of acute migraine attack. The study design was randomized, multicentre, double-blind and double dummy with cross-over on three periods. Of the 198 patients who had three attacks 29.8%, 52.3% and 49.7% had recorded the complete or almost complete disappearance of the pain at 2 h after P, A and ACC respectively. When compared with the placebo, the difference was significant for the A and ACC. When complete disappearance of pain at 2 h was used as a criterion, no significant difference was observed. These results enabled the sensitivity of the evaluation criteria suggested for clinical trials of migraine attack to be discussed.

scholarly journals Sublingual Delivery of Frovatriptan: An Indication of Potential Alternative Route

2014 ◽  
Vol 2014 ◽  
pp. 1-9
Author(s):  
Hitesh Verma ◽  
Surajpal Verma ◽  
Shyam Baboo Prasad ◽  
Harmanpreet Singh
Keyword(s):  
Migraine Attack ◽  
Ex Vivo ◽  
Acute Migraine ◽  
Onset Of Action ◽  
Permeation Studies ◽  
Potential Alternative ◽  
Histopathological Studies ◽  
Sublingual Delivery ◽  
Acute Migraine Attack

Frovatriptan, a 5-HT1B and 5-HT1D receptor agonist, is used for the treatment of acute migraine attack. This molecule is classified into second line therapy because of its slow onset of action (peak response obtained after 4 hours of administration) and low bioavailability (25%). Moreover, its therapy is the most costly among all triptans. Attempt has been made in present work to suggest a way out to fasten its onset of action and to enhance its bioavailability. Prepared tablets were evaluated by physicochemical tests, in vitro permeation studies, ex vivo permeation studies, and histopathological studies. Suitable mathematical calculations were performed to calculate the minimum amount of bioavailability that could be enhanced. Tablets containing chitosan (5% w/w) were found to give optimum results. Prepared tablets can double the bioavailability of frovatriptan and can initiate its response within 10 minutes of its administration. Suggestive alternative has the potential to increase the efficacy of frovatriptan for treating acute migraine attack.

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