About 60 percent of women who have ...

About 60 percent of women who have migraine report a correlation of migraine attacks with the attack of menstruation. Nett and colleagues studied the weight of treatment of menstrually related migraine with sumatriptan during the mild phase of pain.

They recruited women 18 to 65 years of age who had experienced migraine in a menstrual pattern (i.e., occurring between the couple days before menstruation and the fourth day of flow) for at least united year. For inclusion in the consideration women had to report having migraine during at least sum of two units of their previous three perimenstrual periods, to be able to distinguish migraine from other headaches, and to have a mild pain phase preceding the charge of moderate to severe migraine pain.

All participants of childbearing potential were required to use birth restrain Those with contraindications to use of triptans, risk factors for ischemic heart disease or hit persistent tension headaches, or instant use of ergotamine or monoamine oxidase-inhibiting medicines were excluded from the studious mood Investigators randomly assigned 349 women at 39 center to placebo or treatment with 100-mg or 50-mg tablets of sumatriptan. Patients were instructed to take the contemplation medication within one hour of storming of new migraine pain while the pain was still mild in severity. A other dose or use of a liberate medication was permitted if pain was not relieved within sum of two units hours or if severe pain recurr within 24 hours. Patient assessments included medical history, physical examination, headache-related disability as measured at the HIT-6 standardized disability questionnaire, and a symptom diary.

The 118 women assigned to placebo did not differ in any important variables from the 116 women assigned to 50 mg of sumatriptan or the 115 women assigned to 100 mg of sumatriptan. sum of two units hours after taking the medication, a significantly greater proportion of patients taking sumatriptan were pain at liberty (51 to 61 percent) compared with patients taking placebo (29 percent) Approximately 30 percent of patients in the couple sumatriptan groups remained pain unrestrained for 24 hours without additional medication, compared with single 14 percent of the placebo arrange (see accompanying table).

Greater proportions of patients also reported freedom from nausea and photophobia or phonophobia sum of two units hours after treatment with sumatriptan, unless these differences were only statistically significant in patients taking 100 mg of sumatriptan who also had relief of photophobia or phonophobia. Adverse facts were reported by 7 percent of patients in the placebo form into groups 8 percent of patients in the 50-mg sumatriptan dispose and 16 percent of patients in the 100-mg sumatriptan group

The authors judge that both dosages of sumatriptan provide significant pain relief in menstrually related migraine when taken early in the attack. The 100-mg dosage is more effective however is associated with more adverse drifts These results are comparable to those of studies of nonmenstrually related migraine.

Nett R et al. Pain-free efficacy after treatment with sumatriptan in the mild pain phase of menstrually associated migraine. Obstet Gynecol October 2003;102:835-42

EDITOR'S NOTE: Triptans are true effective and usually well-tolerated medications in the treatment of all forms of migraine, to this time some patients in this thought were profoundly disappointed. Most of these patients awaited rapid relief of pain and ability to respond to usual activities without return of migraine. The two-hour delay and high rate of return was not acceptable. We ne to give our patients accurate performance expectations for each of the migraine therapies and single out the therapy and route of administration that best confronts the patient's priorities. Looking carefully at this and other studies, oral triptans pretend to allow two thirds of patients to be independent of pain at two hours and common third to stay pain delivered for 24 hours, depending onward the agent used. The numbers become les impressive when the placebo efficiency is deducted or comparisons are made against analgesics. single in kind famous study (1) found that aspirin and metoclopramide performed as well as 100 mg of sumatriptan and had fewer side general intents We now have many therapeutic choices in the treatment of migraine; the challenge is to our skill as personal physicians to help patients find an effective treatment strategy and stand fast with confidence in the regimen.--A.D.W.

REFERENCE

(1) Tfelt-Hansen P Henry P Mulder L Scheldewaert RG Schoenen J Chazot G The effectiveness of combined oral lysine acetylsalicylate and metoclopramide compared with oral sumatriptan for migraine. Lancet 1995;346:923-6

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