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Panel: Triptans Safely Relieve Migraine Pain

4 out of 5 Sufferers Could Benefit From Migraine Treatment With Triptans
WebMD Health News

May 5, 2004 -- As many as four out of five people who suffer from painful migraines could benefit from treatment with a class of drugs known as triptans, according to a new report. But as little as one in five migraine sufferers actually get the drugs.

A panel of headache experts found that the potential for pain relief and improvement in quality of life provided by triptans, such as Imitrex, Zomig, and others, far outweigh the potential risks for most people with migraines.

Researchers say many doctors may be reluctant to prescribe triptans for migraine treatment due to concerns that these drugs may cause serious heart problems.

But the panel's review of nearly three dozen studies as well as the FDA's adverse event reports on triptans showed that these concerns are generally unfounded for people without heart disease risk factors.

"While serious cardiovascular adverse events have been reported after the use of triptans, their occurrence appears to be extremely low, on the order of less than one per 1 million," says researcher David Dodick, MD, director of the Mayo Clinic Headache Program in Scottsdale, Ariz.

Dodick headed the Triptan Cardiovascular Safety Expert Panel convened by the American Headache Society to look at the safety of triptans in migraine treatment. Their findings appear in the May issue of the journal Headache.

Panel Recommends Triptans for Migraine Treatment

Seven triptans are approved by the FDA for migraine treatment:

  • Amerge
  • Axert

  • Frova

  • Imitrex

  • Maxalt

  • Relpax

  • Zomig     

The pain of migraines is caused by inflammation and increased blood flow through arteries in the head due to enlarged blood vessels. Triptans work by narrowing blood vessels and relieving some of this swelling associated with migraines. In people with heart disease or high blood pressure, this effect may reduce blood flow to the heart too much and lead to complications.

But in their review, researchers found no serious heart-related problems, such as heart attack, reported in 18 studies of triptan use in people with no known heart disease. The studies showed that chest pain or pressure occurred in 1% to 10% of people who take triptans, but these effects were generally mild.

Overall, the study showed the risk of a serious heart-related complication due to triptans was less than one in 1 million.

In contrast, Dodick says the risk of death associated with another class of medications that migraine sufferers frequently turn to, known as nonsteroidal anti-inflammatory drugs (NSAIDs), is as much as one in 200.

NSAIDs, such as ibuprofen, aspirin, and naproxen, have been linked to more than 16,000 deaths per year from people who take them to relieve arthritis pain. The deaths are mostly due to stomach or intestinal bleeding.

Although many drugs come with a certain level of risk, Dodick says the overwhelming benefit that this class of drugs gives to migraine patients favors their use in the absence of certain situations.

Triptans are not recommended for migraine treatment in people with heart disease, pregnant women, or those with certain rare forms of migraine.

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