Treatment of migraine with rizatriptan: when to take the medication

To assess, in the setting of routine clinical practice, rizatriptan's effectiveness in treating acute migraine at its onset versus in a later phase of the attack.

Although the efficacy and tolerability of rizatriptan have been well documented in clinical trials, no information is available about the impact of the timing of medication use on clinical outcome.

Migraineurs were enrolled in a prospective study and treated with rizatriptan 10 mg for two migraine attacks. Patients reported how they used the medication and treatment outcomes via an interactive voice response system. Outcome variables assessed included: time to onset of headache relief, headache severity 2 hours postdose and whether or not patients became largely symptoms-free (including associated symptoms), and when they were able to resume normal activities. Episodes in which patients took rizatriptan immediately after experiencing headache were designated "early use" and those in which patients delayed treatment until their headaches evolved to become moderate or severe were designated as "delayed use." Generalized estimating equations were used to assess the impact of early drug use and to control for age, gender, drug formulation, use of other migraine prescription medications before taking rizatriptan, attack sequence, migraine attack frequency, and recent migraine severity.

A total of 1919 migraineurs with 3450 migraine attack episodes were evaluated, of which 1369 episodes were early use and 2081 delayed use. Compared to delayed-use episodes, episodes wherein patients took rizatriptan early were 1.33 times more likely to be characterized by onset of headache relief within 30 minutes posttreatment (95% confidence interval [CI], 1.11 to 1.60), 1.32 times more likely to result in a largely symptom-free state (95% CI, 1.12 to 1.57), and 1.34 times more likely to be associated with a return to normal activities (95% CI, 1.13 to 1.58) within 1 hour posttreatment. No significant difference between early-use and delayed-use episodes was observed with respect to the likelihood of there being no or mild headache 2 hours posttreatment (odds ratio, 1.05; 95% CI, 0.90 to 1.24).

Whether taken at headache onset or later in the attack, rizatriptan was equally effective in relieving acute migraine headache by 2 hours postdose. Taking rizatriptan at the onset of headache was associated with more rapid relief of headache and reversal of functional disability.