Within-patient early versus delayed treatment of migraine attacks with almotriptan: the sooner the better.
BACKGROUND
Migraine sufferers typically have been instructed to delay triptan therapy until headache intensity is at least moderate. Recent data suggest that earlier use of triptans may be more beneficial.


OBJECTIVE
To address the potential "within-patient" benefit of intervention with almotriptan 12.5 mg for migraine headache of mild intensity.


METHODS
We performed a post hoc analysis of a subgroup of patients from a large, open-label, long-term clinical trial wherein 762 migraineurs used almotriptan 12.5 mg for headache attacks of any severity. Specifically, we evaluated the efficacy and safety of treatment in those patients who had treated at least 3 "mild" attacks and 3 "moderate/severe" attacks, examining rates of pain-free status, use of rescue medication, early recurrence, and adverse events for the first 3 mild and the first 3 moderate/severe attacks treated.


RESULTS
There were 118 migraineurs and 708 attacks available for analysis. At 1 hour following treatment, pain-free status was achieved in 47% of mild attacks versus 14% of moderate/severe attacks (P<.001); incidences at 2 hours were 84% of mild attacks and 53% of moderate/severe attacks (P<.001). The chance of achieving pain-free status at 1 hour in at least 2 of 3 treated attacks was 45% for mild attacks and 9% for moderate/severe attacks; at 2 hours the percentages were 88% for mild attacks and 56% for moderate/severe attacks. Rescue medication was required in 8% of mild attacks and in 13% of moderate/severe attacks (P<.01). The incidence of early recurrence was 28% for mild attacks and 33% for moderate/severe attacks (P<.01). There was no difference in the incidence of adverse events for mild versus moderate/severe attacks (6% versus 7%).


CONCLUSIONS
These results support early intervention with oral triptan therapy. When used for mild intensity head pain, almotriptan 12.5 mg produced a significantly higher incidence of pain-free status at 1 and 2 hours and lower incidences of early headache recurrence or need for rescue medication.
Pascual
Julio
J
Service of Neurology, University Hospital Marqués de Valdecilla, Santander, Spain.
Cabarrocas
Xavier
X
D000284:Administration, Oral; D000328:Adult; D004334:Drug Administration Schedule; D006801:Humans; D007211:Indoles / Q000008:administration & dosage* / Q000627:therapeutic use; D008137:Longitudinal Studies; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy*; D012008:Recurrence; D017366:Serotonin Receptor Agonists / Q000008:administration & dosage* / Q000627:therapeutic use; D016896:Treatment Outcome; D014363:Tryptamines
D007211:Indoles; D017366:Serotonin Receptor Agonists; D014363:Tryptamines; C409045:almotriptan