Reduced efficacy of sumatriptan in migraine with aura vs without aura.
Author(s): Hansen JM(1), Goadsby PJ(2), Charles A(2).
Affiliation(s): Author information:
(1)From the Headache Research and Treatment Program (J.M.H., A.C.), Department of
Neurology, University of California Los Angeles; Headache Group (P.J.G.),
Department of Neurology, University of California San Francisco; NIHR-Wellcome
Trust Clinical Research Facility (P.J.G.), King's College, London, UK; and Danish
Headache Centre and Department of Neurology (J.M.H.), Glostrup Hospital, Faculty
of Health and Medical Sciences, University of Copenhagen, Denmark.
jmh@dadlnet.dk. (2)From the Headache Research and Treatment Program (J.M.H.,
A.C.), Department of Neurology, University of California Los Angeles; Headache
Group (P.J.G.), Department of Neurology, University of California San Francisco;
NIHR-Wellcome Trust Clinical Research Facility (P.J.G.), King's College, London,
UK; and Danish Headache Centre and Department of Neurology (J.M.H.), Glostrup
Hospital, Faculty of Health and Medical Sciences, University of Copenhagen,
Denmark.
Publication date & source: 2015, Neurology. , 84(18):1880-5
OBJECTIVE: To determine whether acute migraine treatment outcome is different in
migraine with aura compared with migraine without aura.
METHODS: We examined pooled outcome data for sumatriptan treatment of migraine
with and without aura from the sumatriptan/naratriptan aggregate patient
database. We also examined similar outcome data for inhaled dihydroergotamine
(DHE) from a single, large randomized controlled study.
RESULTS: The pooled pain-free rates 2 hours postdose for sumatriptan 100 mg were
significantly higher in patients treating attacks without aura (32%) compared
with the group who treated attacks with aura (24%) (p < 0.001). The relative risk
for pain freedom 2 hours postdose for attacks without aura was 1.33 (95%
confidence interval: 1.16-1.54). The number needed to treat for 2 hours of pain
freedom was 4.4 for attacks without aura and 6.2 for attacks with aura. For the
clinical trial of DHE, the 2-hour pain-free rates did not differ between patients
treating attacks without aura (29.4%) compared with those who treated attacks
with aura (27.2%; p = 0.65). The relative risk for pain freedom 2 hours postdose
for attacks without aura vs with aura was 1.08 (95% confidence interval:
0.77-1.53). The number needed to treat for 2 hours pain free was 5.8 for attacks
without aura and 5.0 for attacks with aura.
CONCLUSION: This post hoc analysis of pooled data from multiple randomized trials
indicates that sumatriptan is less effective as acute therapy for migraine
attacks with aura compared with attacks without aura. In the single study of
inhaled DHE, the treatment had similar efficacy for migraine attacks with and
without aura. Different responses of migraine with vs without aura to acute
therapies may provide insight into underlying migraine mechanisms and influence
the choice of acute therapies for different types of migraine attacks.
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