Migraine Drugs Pose Little Heart Risk
Women With No Heart Disease History May Safely Take Triptans to Treat Migraine
July 22, 2004 -- Drugs like Imitrex and Zomig are safe for millions of women who need migraine relief. But for those at high risk of heart disease, think twice about taking them, a new study shows.
Both Imitrex and Zomig belong to a class of drugs called triptans and are highly effective in cutting the disabling pain of migraines. They are a first-line treatment when severe migraines are not relieved by aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs).
Migraines are caused by abnormal activation and inflammation of nerves. Triptans stop this process, relieving pain and other migraine symptoms. The drugs have improved quality of life for many, many migraine sufferers.
But these drugs also seem to constrict blood vessels in the heart, which has raised concerns about people with heart disease who take them, writes lead researcher Lori A. Orlando, MD, with Duke University Medical Center. Her study appears in this month's issue of the journal Headache.
To confuse matters, a condition called "chest syndrome" plagues some migraine sufferers taking these drugs. Within 30 minutes of taking the drug, they feel the chest or throat tighten, a sense of heaviness, and pressure, writes Orlando. While the unsettling sensations disappear within an hour, they cause concern for patients and their doctors.
The American Headache Society recommends that people with heart disease should not take triptan drugs. But how safe are the drugs for people who don't have any known heart-related symptoms? Should they get tested for heart disease before getting a prescription for a triptan drug?
Triptans vs. No Triptans
In her study, Orlando used data on migraine sufferers who took part in previous studies. Through a complex computer analysis, she outlined the risks and benefits of taking the drugs vs. not taking them.
She found similar numbers of heart attacks and deaths from heart disease among all the migraine sufferers -- whether they took the drugs or not, whether they had heart disease or not, Orlando reports.
There was no increased heart attack risk in people taking the triptans, but there was huge headache relief -- 70% fewer migraines -- among those taking triptan drugs, Orlando reports.
It's all about quality of life, she writes. Requiring heart disease testing only for those individuals with very high risk will allow many to get migraine relief and better quality of life.
After all, migraine sufferers typically aren't at high risk for heart attacks, since young women commonly get them, Orlando explains. At menopause, when a woman's heart disease risk increases, the rates of migraine drop by two-thirds.
"It's a risk-over-benefit question," says Orlando in a news release. "There's a one-in-a-million chance that using triptans could lead to heart disease in healthy people."
SOURCE: News release, Duke University School of Medicine. Orlando, L. Headache, July/August 2004: pp 652-660.