Chest symptoms after sumatriptan: a two-year clinical practice review in 735 consecutive migraine patients.
OBJECTIVE
To assess, in clinical practice, the (i) incidence, (ii) within-patient consistency, and (iii) clinical spectrum of chest symptoms (chest symptoms) after subcutaneous (sc) and oral sumatriptan, and (iv) to identify risk factors for chest symptoms.


METHODS
Two-year retrospective survey with mailed self-administered questionnaire.


METHODS
Neurology outpatient clinic of university hospital.


METHODS
Migraine patients with or without aura (n = 869).


METHODS
Incidence, within-patient consistency and characteristics of chest symptoms; demographic and clinical characteristics of patients.


RESULTS
There were 735 (85%) respondents. Sumatriptan was used by 453 patients, during 25 months (median), for 28000 attacks (median: 33 attacks/patient). Of sumatriptan users, 41% (sc) and 24% (oral) had chest symptoms in all attacks, 39% (sc) and 58% (oral) in none, and the remaining in some attacks. Because of chest symptoms, 10% discontinued sumatriptan. Chest symptoms mostly consisted of heavy arms and chest pressure, started within 5 (sc) to 30 (oral) min, and lasted 30 (sc) to 60 (oral) min. Compared with patients without chest symptoms, patients with chest symptoms more often were females and younger, and went to rest immediately after sumatriptan administration (all p < 0.001); they also tended to have lower body mass indices, more severe attacks and less efficacy of sumatriptan (all 0.001 < p < 0.05). Patients with chest symptoms had no higher incidence of cardiovascular symptoms or risk factors.


CONCLUSIONS
Chest symptoms are frequent, within-patients consistent, but rarely important, adverse events of (notably sc) sumatriptan. The risk of chest symptoms is patient-dependent and not related, even opposite, to cardiovascular disease. This contradicts the hypothesis that chest symptoms after sumatriptan are caused by cardiac ischemia. Patient acceptance of chest symptoms is improved by pre-advising on the risk and nature of chest symptoms.
Visser
W H
WH
Department of Neurology, University Hospital, Leiden, The Netherlands.
Jaspers
N M
NM
de Vriend
R H
RH
Ferrari
M D
MD
D000328:Adult; D000787:Angina Pectoris / Q000139:chemically induced*; D002637:Chest Pain / Q000139:chemically induced; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D017366:Serotonin Receptor Agonists / Q000009:adverse effects* / Q000627:therapeutic use; D018170:Sumatriptan / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D014662:Vasoconstrictor Agents / Q000009:adverse effects* / Q000627:therapeutic use
D017366:Serotonin Receptor Agonists; D014662:Vasoconstrictor Agents; D018170:Sumatriptan