title: Hair analysis for detection of triptans occasionally used or overused by migraine patients-a pilot study.
abstract: OBJECTIVE
  The aim of this study is to evaluate the detection rate of almotriptan, eletriptan, frovatriptan, sumatriptan, rizatriptan, and zolmitriptan in the hair of migraineurs taking these drugs; the degree of agreement between type of self-reported triptan and triptan found in hair; if the concentrations in hair were related to the reported cumulative doses of triptans; and whether hair analysis was able to distinguish occasional use from the overuse of these drugs.
  
  
  METHODS
  Out of 300 headache patients consecutively enrolled, we included 147 migraine patients who reported to have taken at least one dose of one triptan in the previous 3 months; 51 % of the patients overused triptans. A detailed pharmacological history and a sample of hair were collected for each patient. Hair samples were analyzed by liquid chromatography-electrospray tandem mass spectrometry (LC-MS/MS) by a method that we developed.
  
  
  RESULTS
  All the triptans could be detected in the hair of the patients. The agreement between type of self-reported triptan and type of triptan found in hair was from fair to good for frovatriptan and zolmitriptan and excellent for almotriptan, eletriptan, sumatriptan, and rizatriptan (P < 0.01, Cohen's kappa). The correlation between the reported quantities of triptan and hair concentrations was statistically significant for almotriptan, eletriptan, rizatriptan, and sumatriptan (P < 0.01, Spearman's rank correlation coefficient). The accuracy of hair analysis in distinguishing occasionally users from overusers was high for almotriptan (ROC AUC = 0.9092), eletriptan (ROC AUC = 0.8721), rizatriptan (ROC AUC = 0.9724), and sumatriptan (ROC AUC = 0.9583).
  
  
  CONCLUSIONS
  Hair analysis can be a valuable system to discriminate occasional use from triptan overuse.
authors.affiliation: Unit of Medical Toxicology, Headache Centre and Drug Abuse, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico, Via del Pozzo, 71, 41124, Modena, Italy. anna.ferrari@unimore.it.
authors.forename: Anna
authors.initials: A
authors.lastname: Ferrari
authors.affiliation: Unit of Medical Toxicology, Headache Centre and Drug Abuse, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico, Via del Pozzo, 71, 41124, Modena, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Baraldi
authors.affiliation: Forensic Toxicology Laboratory, Department of Diagnostic Medicine, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Licata
authors.affiliation: Forensic Toxicology Laboratory, Department of Diagnostic Medicine, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Vandelli
authors.affiliation: Forensic Toxicology Laboratory, Department of Diagnostic Medicine, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Marchesi
authors.affiliation: Forensic Toxicology Laboratory, Department of Diagnostic Medicine, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Palazzoli
authors.affiliation: Forensic Toxicology Laboratory, Department of Diagnostic Medicine, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Verri
authors.affiliation: Department of Life Sciences, University of Modena and Reggio Emilia, via G. Campi, 103, 41125, Modena, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Rustichelli
authors.affiliation: Anaesthesiology, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Giuliani
authors.affiliation: Unit of Forensic Medicine, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Silingardi
mesh_terms: D000328:Adult; D005260:Female; D006197:Hair / Q000737:chemistry*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy; D010865:Pilot Projects; D000067490:Prescription Drug Overuse; D014363:Tryptamines / Q000032:analysis* / Q000627:therapeutic use
chemical_list: D014363:Tryptamines
keywords: Hair analysis; Medication-overuse headache; Migraine; Monitoring; ROC curve; Triptan