The Pharmaceutical Journal
Vol 273 No 7310 p140
31 July 2004

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New triptan is effective in menstrual migraine

Menstrual migraine is different from non-menstrual migraine, being more severe. But a new triptan has been shown to be effective in reducing the syptomes of this condition when taken prophylactically.

These mixed findings about menstrual migraine are published this week. Anne MacGregor, City of London Migraine Clinic, and colleague confirm that migraine does indeed occur in many women around menstruation. Looking at 155 women complaining of menstrual migraine, they found that an attack was 1.7 times more likely during the two days before menstruation and 2.5 times more likely during the first three days of menstruation than at other times in the cycle. In addition, these attacks were more severe than non-menstrual migraine, having double and triple severity, respectively (Neurology 2004;63:351).

However, data from a US trial published in the same journal show that twice daily frovatriptan (Migard) prevented menstrual migraine in over half of patients using it prophylactically. The trial involved 546 women who were known to suffer from predictable menstrual migraine. On three consecutive attacks women took frovatriptan 2.5mg once a day, frovatriptan 2.5mg twice a day or placebo in a double-blind crossover design. A double loading dose of frovatriptan was given to start the course.

Treatments were taken for six days starting two days before the anticipated start of a menstrually associated migraine (MAM).

The incidence of MAM was 67 per cent for placebo, 52 per cent for frovatriptan daily and 41 per cent for the twice-daily regimen. The researchers report that the incidence of adverse effects was similar with active drug and placebo.

They add that the findings are consistent with the long duration of action and good tolerability of frovatriptan observed in short-term migraine management (Neurology 2004;63:261).

In an accompanying article, commentator Elizabeth Loder, Harvard Medical School, Boston, describes the effects of frovatriptan as modest, though “not to be sneered at”. Treatment efficacy was seen over a broad range of endpoints including headache duration, associated symptoms and use of rescue medication. She adds that the use of a loading dose is likely to have contributed to better results in this study as compared with other similar trials of triptan prophylaxis in menstrual migraine which used naratriptan.

She adds that “timing is everything in short-term prevention regimens for menstrual migraine, with success presumably dependent on starting treatment before headache onset.” She questions how certainly optimal timing can be achieved in a clinical population (ibid, p202).