Overuse of migraine drug increases cardiac risk

The overuse of ergotamine increases the risk of cardiovascular complications, such as heart attack and stroke, among migraine patients who are taking drugs for cardiovascular disease, according to a report in the journal Neurology. However, this effect was not seen with triptans, another class of drugs frequently prescribed for migraine.

Ergotamine, which belongs to a group of drugs referred to as ergot alkaloids, is prescribed to patients with migraine or other types of severe headache under the trade name Ergomar and several others. It is also available in combination with caffeine, under trade names such as Wigraine and Cafergot, and with other drugs.

Because ergotamine causes blood vessels to narrow, serious side effects may develop as the flow of blood carrying oxygen to the body's tissues is diminished.

Prescribers sometimes weigh the low risk of cardiovascular events against the increased quality of life from pain relief when selecting a migraine drug for patients with cardiovascular risk factors, Dr. Elisabeth A. Wammes-van der Heijden told Reuters Health. "In this case, we would recommend prescribing a triptan and not ergotamine."

Wammes-van der Heijden from Utrecht University in the Netherlands and colleagues used a pharmacy dispensing database to identify patients prescribed a triptan or ergotamine. They then found 188 migraine patients who had been hospitalized for a cardiovascular complication and matched them to 689 comparison patients (controls).

In general, the overuse of antimigraine drugs did not increase the risk of hospitalization due to cardiovascular events. However, the overuse of antimigraine drugs among the subset of patients who were also using cardiovascular drugs more than doubled their already elevated risk of complications, the results indicate.

This effect was seen with the simultaneous use of cardiovascular drugs and the overuse of ergotamine, but not with the overuse of triptans.

"If a doctor decides to prescribe an antimigraine drug to a patient with cardiovascular risk factors, in spite of this fact, we indeed would recommend a triptan and not ergotamine," Wammes-van der Heijden said.

The study did not distinguish between patients with low or high cardiovascular risk, Wammes-van der Heijden cautioned. "This means that the prescriber still has to carefully evaluate possible adverse effects before prescribing ergotamine or triptans to a patient."

SOURCE: Neurology October 2006.