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Rational migraine management: optimising treatment with the triptans
1Keele University, ST5 5BG, UK.
Functional Neurology
|February 24, 2001
Summary
Newer triptans (TELs) offer improved efficacy and faster onset than sumatriptan for migraine relief. Naratriptan shows fewer side effects and lower recurrence rates, aiding rational migraine management.
Area of Science:
- Neurology
- Pharmacology
Background:
- Several 5-HT1B/1D agonist triptans with enhanced lipophilicity (TELs) have been developed, including naratriptan, rizatriptan, and zolmitriptan.
- These newer agents offer potential advantages over the first-generation drug, sumatriptan.
Purpose of the Study:
- To critically compare the clinical profiles of newer TELs against sumatriptan.
- To identify objective differences for a rational approach to migraine therapy.
Main Methods:
- Review of recent randomized controlled trials and comparator data.
- Inclusion of independent regulatory assessments, such as the FDA's evaluation of rizatriptan.
Main Results:
- Rizatriptan and zolmitriptan demonstrated superior efficacy compared to sumatriptan, with a more rapid onset of action.
- Naratriptan exhibited lower recurrent headache rates and a favorable adverse event profile, comparable to placebo.
- Zolmitriptan showed significant 24-hour efficacy, comparable to naratriptan.
Conclusions:
- Rizatriptan or zolmitriptan are suitable for first-line treatment of moderate to severe headaches due to superior efficacy and rapid onset.
- Naratriptan or zolmitriptan are appropriate for long-duration or recurrent headaches, such as menstrual migraines.
- Naratriptan is a viable option for patients intolerant to triptan-associated adverse events.