The Pharmaceutical Journal
Vol 269 No 7222 p634
2 November 2002

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Neurology (www.neurology.org)

Restrict triptans to 10 doses a month

Triptan use should be restricted to a maximum of 10 single doses per month, according to researchers from Essen university hospital in Germany.

They investigated the incidence of headaches caused by overuse of acute headache drugs among 96 users of analgesics, ergots and triptans. Most patients included in the study were women who had migraine as their primary headache.

The study showed that overuse of triptans led to medication-overuse headaches (MOH) faster and at lower doses than with the other drugs studied (Neurology 2002;59:1011).

"[The critical intake frequency] was as low as 10 single doses per month in some patients, indicating that an intake of triptans every other or even every third day may be sufficient to develop MOH," they say.

Patients were interviewed about the history of their primary headache and about the development of MOH. The mean duration of primary headache history was 22 years (three to 44 years) and mean duration of drug overuse was 6.5 years (0.5 to 25 years). Of the 96 taking part in the study, 46 overused analgesics, 12 overused ergots and 38 overused triptans. The researchers calculated the time taken for patients to develop MOH by subtracting the duration of MOH from the duration of drug overuse.

They found that this time was shortest in patients overusing triptans and longest in those overusing analgesics (1.7 years versus 4.8 years). They also calculated the critical dose frequency that caused MOH. This was lowest for triptans and highest for analgesics (18 versus 114 single doses per month).

The researchers comment that the pharmacological and clinical presentation of triptan-induced MOH is different from that induced by other acute headache drugs. All patients who overused analgesics and most who overused ergots developed tension-type headaches. However, of the patients overusing triptans almost 40 per cent developed an increase in the frequency of their migraine attacks.