"Sometimes, Migraine patterns change or mutate. There is no need to get a diminishing return from a triptan that may be metabolized too quickly for the existing headache pattern. Therefore, switching to another triptan often makes sense. Do not assume all triptans are created equal." - Dr. John Claude Krusz1*
If your triptans aren't working as well as they used to, you frequently need a second dose, or think you may be experiencing rebound headaches from some of the older triptans, you'll definitely want to continue reading about a study conducted with Relpax (eletriptan).
Study Introduction:
"Eletriptan has just been introduced for Migraine-specific therapy in the
US. This study was done in a headache clinic population where prior triptan
therapy, though successful, was felt to be sub-optimal over time."2
Methods:
The study was conducted with 30 patients who successfully treated their
Migraines with other triptans. They were given 40mg of Relpax® at the onset of a
Migraine. If needed, a repeat dose was allowed one hour later. Keeping a diary,
the patients tracked five or more Migraines they treated with Relpax.
Results:
Of the 30 patients, 24 (80%) reported Relpax® to have been equal to or better
than prior triptan therapy in 120 or the 150 Migraine attacks treated with
Relpax®. Six patients consistently used a second dose. This represented a 20%
recurrence rate as opposed to the 47% recurrence rate these patients had
experienced with their prior triptan therapy. Three patients rated Relpax® as
slightly less efficacious than other triptans they'd used. Three patients
preferred other triptans. Other than dry mouth reported by two patients, no side
effects were reported.
Conclusions:
"Eletriptan is quite effective as acute Migraine-specific therapy. It can
recapture a strong degree of efficacy where prior triptan therapy has
decremented. One can make a strong case to switching therapy to eletriptan where
prior therapies are sub-optimal, or where repeat dosing occurs frequently."1
Discussion of the Results:
"Newer, longer half-life triptans, such as eletriptan, may represent a
therapeutic maneuver to maintain better effectiveness in migraine treatment.
This would seem to be true based on the open-label data in this study. Similar
observations have been made with other longer-lived triptans. For example,
naratriptan was noted to prevent recurrence of migraine 78% of the time in a
population of migraineurs known to experience recurrence with sumatriptan. Very
recently, long-term administration of daily naratriptan for up to six months did
not give any evidence of rebound and helped convert chronic refractory migraine
to an episodic pattern.
Some studies have reported a better efficacy of eletriptan over sumatriptan
regarding sustained headache response, sustained pain-free response and
functional response. Eletriptan was also found to be highly effective in a
population of migraineurs who had not achieved satisfactory with Excedrin
Migraine6. These studies are in agreement with the findings of the present
open-label study and should be verified via double-blind studies in the future."
Summary:
If you've read our forums or written to me about one
triptan
not working for you, you've been advised to talk to your doctor about trying
other triptans. Each of them bind to different receptors, so each of them has
the potential to work for us, even when other's haven't. At this time, there are
seven triptans:
- sumatriptan (Imitrex®, Imigran®)
- rizatriptan (Maxalt®)
- zolmitriptan (Zomig®)
- naratriptan (Amerge®, Naramig®)
- almotriptan (Axert®)
- frovatriptan (Frova®)
- eletriptan (Relpax®)
The newer triptans have a longer half-life, and are less likely to require repeat dosing. Although there's no real consensus among doctors, many feel that some of the older triptans such as sumatriptan, rizatriptan, and zolmitriptan may cause rebound headaches in some patients. Preliminary studies, particularly one of frovatriptan for menstrually associated Migraine, show that the newer triptans have less potential for rebound. As Dr. Krusz says, "Do not assume all triptans are created equal."
* Please Note:
Dr. John Claude Krusz very kindly volunteers his services to assist with out
weekly Ask the
Clinician feature.
____________________
References:
1 Krusz, John Claude and Robert, Teri. Personal Interview. December 15, 2003.
2 Stein, Jill. "ANA: Eletriptan Improves Efficacy When Earlier
Triptans Fail." Doc Guide. October 28, 2003.
http://www.docguide.com/dg.nsf/DGNews/678886B79BE0BB8285256DCD007633D9?OpenDocument&f=y
3 John Claude Krusz, PhD, MD and William R. Knoderer, DDS, MD
Anodyne Headache and PainCare, Dallas, Texas, USA. Poster presentation from the
XI Congress of the International Headache Society, September, 2003.
