‘Triptan’ drug can prevent menstrual migraine

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A drug used to treat acute migraine seems to prevent some of the migraines women experience around the time of menstruation, researchers announced Monday.

Previous research has shown that women who suffer migraines are twice as likely to have one during the first 2 days of their period than during the rest of the month. 

These so-called “menstrual migraines” - which can develop between two days before and four days after the onset of menses - often last longer, are harder to treat and more likely to recur than other types of migraine.

Many times, menstrual migraines are treated with newer birth control pills that reduce women’s periods to 3 to 4 times per year, or with over-the-counter migraine medicines, which need to be taken several times per day, study author Dr. Stephen A. Silberstein told Reuters Health.

Now, he and his colleagues have found that women who started taking one of the newer “triptan” drugs, frovatriptan, a few days before they would typically get a menstrual migraine got fewer migraines during their periods. And for people who did get migraines, they were less severe and didn’t last as long, according to the team’s report in the journal Neurology.

“Patients now have good options to treat menstrual migraine,” Silberstein said in an interview.

He recommended that women who opt to take frovatriptan, sold under the brand name Frova, start the treatment 2 days before they expect to get their period, and continue it for 6 or 7 days.

During the study—which was supported by the makers of frovatriptan—Silberstein and his colleagues asked 546 women with menstrual migraine to take frovatriptan once per day or twice per day, or a placebo drug. Women started the treatment 2 days before they expected a migraine, and continued it for 6 days. Each woman tried each treatment during the course of the study.

The researchers found that when women took a placebo, 67 percent developed a menstrual migraine. However, when they took frovatriptan once per day, only 52 percent of women developed migraine, and taking the drug twice per day reduced the rate to 41 percent.

Migraines that occurred after taking frovatriptan were typically less severe and disappeared more quickly than migraines that occurred during placebo treatment.

Side effects were just as likely to occur with the placebo drug as with frovatriptan, the authors note.

Silberstein, who is based at Thomas Jefferson University in Philadelphia, explained that migraine occurs when the lining of the brain becomes inflamed. “That’s how the drug works,” he said. “It prevents that from happening.”

Silberstein and some of his co-authors also have received honoraria from UCB Pharma or Elan Pharmaceuticals, which co-market the drug.

In an accompanying editorial, Dr. Elizabeth Loder of Harvard Medical School and Spaulding Rehabilitation Hospital in Boston writes that “timing is everything” for menstrual migraine, and treatment likely succeeds only when it is started before migraine occurs.

She adds that, unfortunately, monthly use of the drug is “unlikely to be reimbursed by most third-party payers, effectively placing treatment out of reach for many women.”

SOURCE: Neurology, July 2004.
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