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A retrospective analysis of triptan and dhe use for basilar and hemiplegic migraine
Background Patients with basilar migraine (BM) and hemiplegic migraine (HM) have been excluded from triptan and DHE clinical trials due to a potential risk of ischemic vascular events, and the FDA mandates that package labeling state that they are contraindicated in BM and HM. The objective of this...
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| Published in: | Headache 2016-05, Vol.56 (5), p.841-848 |
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| creator | Mathew, Paul G. Krel, Regina Buddhdev, Bhuvin Ansari, Hossein Joshi, Shivang G. Spinner, Warren D. Klein, Brad C. |
| description | Background
Patients with basilar migraine (BM) and hemiplegic migraine (HM) have been excluded from triptan and DHE clinical trials due to a potential risk of ischemic vascular events, and the FDA mandates that package labeling state that they are contraindicated in BM and HM. The objective of this study was to demonstrate that triptans and DHE can be used for the abortive treatment of BM and HM without significant adverse ischemic vascular events.
Methods
A retrospective chart review of patients with BM features or HM who received acute abortive treatment with either triptans or DHE was conducted at 4 headache centers to assess the frequency of ischemic vascular events after administration. The diagnoses of BM or HM were made by headache specialists based on The International Classification of Headache Disorders, 2nd edition (ICHD‐II). Searchable terms included BM, vertigo, dysarthria, diplopia, hemiplegia/hemiparesis, facial droop, weakness, confusion, altered consciousness, confusion, ataxia, and aphasia, as well as all triptans or DHE.
Results
The study included 67 patients with BM features and 13 patients with HM. Among those receiving triptans, 40 were in the BM group and 5 were in the HM group. Among those receiving DHE, 27 were included in the BM group and 8 were in the HM group. No side effects of stroke or myocardial infarction were reported. In the triptan group, 5 patients reported adverse effects that included GI upset, rash, neck dystonia, nightmares, and flushing. In the DHE group, 5 patients had adverse events that included chest tightness, dystonic reaction, transient asymptomatic anterior T wave inversion, and agitation.
Conclusion
In this retrospective study, triptans and DHE were used with no reported, subsequent acute/subacute ischemic vascular events for the abortive treatment of migraines with basilar and hemiplegic‐type features. Although the small sample sizes generated theoretical statistical event rates of 4.5% for BM and 23% for HM, there has been no clear evidence that BM and HM carry an actual elevated risk for vascular events compared with migraine with aura. |
| doi_str_mv | 10.1111/head.12804 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1826667082</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>4052563471</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4544-31e33c31b4fae82e540a047598bc59ee983be90906f3532eab8f1a670edb78d83</originalsourceid><addsrcrecordid>eNqF0U9P2zAYBnBrAo2u7LIPMFnaZUJK8X87xw4oTEJwgG1Hy0neUEPSBDuB9dvPpcCBw_DFkvV7H0vvg9AXSmY0ncMluGpGmSHiA5pQyVQmFCU7aEII1ZnRwuyhTzHeEkKEytVHtMc0UUwyM0FXcxxgCF3soRz8A2C3cs06-oi7Gg_B94NbpbcKV0vAYwRcdwEXLvrGhaf3JbS-b-DGl7j1N8H5Feyj3do1ET4_31P0a3FyfXSWnV-e_jyan2elkEJknALnJaeFqB0YBlIQR4SWuSlKmQPkhheQk5yomkvOwBWmpk5pAlWhTWX4FH3f5vahux8hDrb1sYSmcSvoxmipYUolb9j7VKePlGZaJfrtDb3txpC2slHGsLREyZM62Koy7S4GqG0ffOvC2lJiN63YTSv2qZWEvz5HjkUL1St9qSEBugWPvoH1f6Ls2cn8-CU02874OMDf1xkX7qzSXEv75-LUmmux-P1DMrvg_wBlSKRw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1788200453</pqid></control><display><type>article</type><title>A retrospective analysis of triptan and dhe use for basilar and hemiplegic migraine</title><source>Wiley-Blackwell Journals</source><creator>Mathew, Paul G. ; Krel, Regina ; Buddhdev, Bhuvin ; Ansari, Hossein ; Joshi, Shivang G. ; Spinner, Warren D. ; Klein, Brad C.</creator><creatorcontrib>Mathew, Paul G. ; Krel, Regina ; Buddhdev, Bhuvin ; Ansari, Hossein ; Joshi, Shivang G. ; Spinner, Warren D. ; Klein, Brad C.</creatorcontrib><description>Background
Patients with basilar migraine (BM) and hemiplegic migraine (HM) have been excluded from triptan and DHE clinical trials due to a potential risk of ischemic vascular events, and the FDA mandates that package labeling state that they are contraindicated in BM and HM. The objective of this study was to demonstrate that triptans and DHE can be used for the abortive treatment of BM and HM without significant adverse ischemic vascular events.
Methods
A retrospective chart review of patients with BM features or HM who received acute abortive treatment with either triptans or DHE was conducted at 4 headache centers to assess the frequency of ischemic vascular events after administration. The diagnoses of BM or HM were made by headache specialists based on The International Classification of Headache Disorders, 2nd edition (ICHD‐II). Searchable terms included BM, vertigo, dysarthria, diplopia, hemiplegia/hemiparesis, facial droop, weakness, confusion, altered consciousness, confusion, ataxia, and aphasia, as well as all triptans or DHE.
Results
The study included 67 patients with BM features and 13 patients with HM. Among those receiving triptans, 40 were in the BM group and 5 were in the HM group. Among those receiving DHE, 27 were included in the BM group and 8 were in the HM group. No side effects of stroke or myocardial infarction were reported. In the triptan group, 5 patients reported adverse effects that included GI upset, rash, neck dystonia, nightmares, and flushing. In the DHE group, 5 patients had adverse events that included chest tightness, dystonic reaction, transient asymptomatic anterior T wave inversion, and agitation.
Conclusion
In this retrospective study, triptans and DHE were used with no reported, subsequent acute/subacute ischemic vascular events for the abortive treatment of migraines with basilar and hemiplegic‐type features. Although the small sample sizes generated theoretical statistical event rates of 4.5% for BM and 23% for HM, there has been no clear evidence that BM and HM carry an actual elevated risk for vascular events compared with migraine with aura.</description><identifier>ISSN: 0017-8748</identifier><identifier>EISSN: 1526-4610</identifier><identifier>DOI: 10.1111/head.12804</identifier><identifier>PMID: 27062528</identifier><language>eng</language><publisher>United States: Blackwell Publishing Ltd</publisher><subject>basilar migraine ; dihydroergotamine (DHE) ; Headaches ; Heart attacks ; hemiplegic migraine ; Migraine ; migraine with brainstem aura ; triptan</subject><ispartof>Headache, 2016-05, Vol.56 (5), p.841-848</ispartof><rights>2016 American Headache Society</rights><rights>2016 American Headache Society.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4544-31e33c31b4fae82e540a047598bc59ee983be90906f3532eab8f1a670edb78d83</citedby><cites>FETCH-LOGICAL-c4544-31e33c31b4fae82e540a047598bc59ee983be90906f3532eab8f1a670edb78d83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fhead.12804$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fhead.12804$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,786,790,27957,27958,50923,51032</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27062528$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mathew, Paul G.</creatorcontrib><creatorcontrib>Krel, Regina</creatorcontrib><creatorcontrib>Buddhdev, Bhuvin</creatorcontrib><creatorcontrib>Ansari, Hossein</creatorcontrib><creatorcontrib>Joshi, Shivang G.</creatorcontrib><creatorcontrib>Spinner, Warren D.</creatorcontrib><creatorcontrib>Klein, Brad C.</creatorcontrib><title>A retrospective analysis of triptan and dhe use for basilar and hemiplegic migraine</title><title>Headache</title><addtitle>Headache: The Journal of Head and Face Pain</addtitle><description>Background
Patients with basilar migraine (BM) and hemiplegic migraine (HM) have been excluded from triptan and DHE clinical trials due to a potential risk of ischemic vascular events, and the FDA mandates that package labeling state that they are contraindicated in BM and HM. The objective of this study was to demonstrate that triptans and DHE can be used for the abortive treatment of BM and HM without significant adverse ischemic vascular events.
Methods
A retrospective chart review of patients with BM features or HM who received acute abortive treatment with either triptans or DHE was conducted at 4 headache centers to assess the frequency of ischemic vascular events after administration. The diagnoses of BM or HM were made by headache specialists based on The International Classification of Headache Disorders, 2nd edition (ICHD‐II). Searchable terms included BM, vertigo, dysarthria, diplopia, hemiplegia/hemiparesis, facial droop, weakness, confusion, altered consciousness, confusion, ataxia, and aphasia, as well as all triptans or DHE.
Results
The study included 67 patients with BM features and 13 patients with HM. Among those receiving triptans, 40 were in the BM group and 5 were in the HM group. Among those receiving DHE, 27 were included in the BM group and 8 were in the HM group. No side effects of stroke or myocardial infarction were reported. In the triptan group, 5 patients reported adverse effects that included GI upset, rash, neck dystonia, nightmares, and flushing. In the DHE group, 5 patients had adverse events that included chest tightness, dystonic reaction, transient asymptomatic anterior T wave inversion, and agitation.
Conclusion
In this retrospective study, triptans and DHE were used with no reported, subsequent acute/subacute ischemic vascular events for the abortive treatment of migraines with basilar and hemiplegic‐type features. Although the small sample sizes generated theoretical statistical event rates of 4.5% for BM and 23% for HM, there has been no clear evidence that BM and HM carry an actual elevated risk for vascular events compared with migraine with aura.</description><subject>basilar migraine</subject><subject>dihydroergotamine (DHE)</subject><subject>Headaches</subject><subject>Heart attacks</subject><subject>hemiplegic migraine</subject><subject>Migraine</subject><subject>migraine with brainstem aura</subject><subject>triptan</subject><issn>0017-8748</issn><issn>1526-4610</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><recordid>eNqF0U9P2zAYBnBrAo2u7LIPMFnaZUJK8X87xw4oTEJwgG1Hy0neUEPSBDuB9dvPpcCBw_DFkvV7H0vvg9AXSmY0ncMluGpGmSHiA5pQyVQmFCU7aEII1ZnRwuyhTzHeEkKEytVHtMc0UUwyM0FXcxxgCF3soRz8A2C3cs06-oi7Gg_B94NbpbcKV0vAYwRcdwEXLvrGhaf3JbS-b-DGl7j1N8H5Feyj3do1ET4_31P0a3FyfXSWnV-e_jyan2elkEJknALnJaeFqB0YBlIQR4SWuSlKmQPkhheQk5yomkvOwBWmpk5pAlWhTWX4FH3f5vahux8hDrb1sYSmcSvoxmipYUolb9j7VKePlGZaJfrtDb3txpC2slHGsLREyZM62Koy7S4GqG0ffOvC2lJiN63YTSv2qZWEvz5HjkUL1St9qSEBugWPvoH1f6Ls2cn8-CU02874OMDf1xkX7qzSXEv75-LUmmux-P1DMrvg_wBlSKRw</recordid><startdate>201605</startdate><enddate>201605</enddate><creator>Mathew, Paul G.</creator><creator>Krel, Regina</creator><creator>Buddhdev, Bhuvin</creator><creator>Ansari, Hossein</creator><creator>Joshi, Shivang G.</creator><creator>Spinner, Warren D.</creator><creator>Klein, Brad C.</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7U7</scope><scope>C1K</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201605</creationdate><title>A retrospective analysis of triptan and dhe use for basilar and hemiplegic migraine</title><author>Mathew, Paul G. ; Krel, Regina ; Buddhdev, Bhuvin ; Ansari, Hossein ; Joshi, Shivang G. ; Spinner, Warren D. ; Klein, Brad C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4544-31e33c31b4fae82e540a047598bc59ee983be90906f3532eab8f1a670edb78d83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>basilar migraine</topic><topic>dihydroergotamine (DHE)</topic><topic>Headaches</topic><topic>Heart attacks</topic><topic>hemiplegic migraine</topic><topic>Migraine</topic><topic>migraine with brainstem aura</topic><topic>triptan</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mathew, Paul G.</creatorcontrib><creatorcontrib>Krel, Regina</creatorcontrib><creatorcontrib>Buddhdev, Bhuvin</creatorcontrib><creatorcontrib>Ansari, Hossein</creatorcontrib><creatorcontrib>Joshi, Shivang G.</creatorcontrib><creatorcontrib>Spinner, Warren D.</creatorcontrib><creatorcontrib>Klein, Brad C.</creatorcontrib><collection>Istex</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Headache</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mathew, Paul G.</au><au>Krel, Regina</au><au>Buddhdev, Bhuvin</au><au>Ansari, Hossein</au><au>Joshi, Shivang G.</au><au>Spinner, Warren D.</au><au>Klein, Brad C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A retrospective analysis of triptan and dhe use for basilar and hemiplegic migraine</atitle><jtitle>Headache</jtitle><addtitle>Headache: The Journal of Head and Face Pain</addtitle><date>2016-05</date><risdate>2016</risdate><volume>56</volume><issue>5</issue><spage>841</spage><epage>848</epage><pages>841-848</pages><issn>0017-8748</issn><eissn>1526-4610</eissn><notes>ArticleID:HEAD12804</notes><notes>ark:/67375/WNG-8T4FVB52-F</notes><notes>istex:149A12EAA79E41B8ABD2F82468D60F81784D10D0</notes><notes>There was no outside funding for this study. Dr. Mathew has served as a consultant for Analgesic Solutions and Teva. Dr. Spinner has received speaker honoraria from Allergan and Merz. Dr. Klein has received speaker honoraria from Allergan, the American Academy of Neurology, Depomed, Teva, UCB, USWorldmeds, and Zogenix; he has also served as a PI for the Alder study and Lilly studies. The other authors have no disclosures.</notes><notes>Disclosures</notes><notes>None.</notes><notes>Conflict of Interest</notes><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Background
Patients with basilar migraine (BM) and hemiplegic migraine (HM) have been excluded from triptan and DHE clinical trials due to a potential risk of ischemic vascular events, and the FDA mandates that package labeling state that they are contraindicated in BM and HM. The objective of this study was to demonstrate that triptans and DHE can be used for the abortive treatment of BM and HM without significant adverse ischemic vascular events.
Methods
A retrospective chart review of patients with BM features or HM who received acute abortive treatment with either triptans or DHE was conducted at 4 headache centers to assess the frequency of ischemic vascular events after administration. The diagnoses of BM or HM were made by headache specialists based on The International Classification of Headache Disorders, 2nd edition (ICHD‐II). Searchable terms included BM, vertigo, dysarthria, diplopia, hemiplegia/hemiparesis, facial droop, weakness, confusion, altered consciousness, confusion, ataxia, and aphasia, as well as all triptans or DHE.
Results
The study included 67 patients with BM features and 13 patients with HM. Among those receiving triptans, 40 were in the BM group and 5 were in the HM group. Among those receiving DHE, 27 were included in the BM group and 8 were in the HM group. No side effects of stroke or myocardial infarction were reported. In the triptan group, 5 patients reported adverse effects that included GI upset, rash, neck dystonia, nightmares, and flushing. In the DHE group, 5 patients had adverse events that included chest tightness, dystonic reaction, transient asymptomatic anterior T wave inversion, and agitation.
Conclusion
In this retrospective study, triptans and DHE were used with no reported, subsequent acute/subacute ischemic vascular events for the abortive treatment of migraines with basilar and hemiplegic‐type features. Although the small sample sizes generated theoretical statistical event rates of 4.5% for BM and 23% for HM, there has been no clear evidence that BM and HM carry an actual elevated risk for vascular events compared with migraine with aura.</abstract><cop>United States</cop><pub>Blackwell Publishing Ltd</pub><pmid>27062528</pmid><doi>10.1111/head.12804</doi><tpages>8</tpages></addata></record> |
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| ispartof | Headache, 2016-05, Vol.56 (5), p.841-848 |
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| language | eng |
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| source | Wiley-Blackwell Journals |
| subjects | basilar migraine dihydroergotamine (DHE) Headaches Heart attacks hemiplegic migraine Migraine migraine with brainstem aura triptan |
| title | A retrospective analysis of triptan and dhe use for basilar and hemiplegic migraine |
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