Efficacy of frovatriptan and other triptans in the treatment of acute migraine ofhypertensive and normotensive subjects: a review of randomized studies.

摘要

Migraine might be associated with high blood pressure (BP), which can cause more severe and more difficult to treat forms of headache. To evaluate the efficacy offrovatriptan and other triptans in the acute treatment of migraine, in patientsclassified according to a history of arterial hypertension, enrolled in threerandomized, double-blind, crossover, Italian studies. Migraineurs with or withoutaura were randomized to frovatriptan 2.5 mg or rizatriptan 10 mg (study 1),frovatriptan 2.5 mg or zolmitriptan 2.5 mg (study 2), frovatriptan 2.5 mg oralmotriptan 12.5 mg (study 3). After treating up to three episodes of migraine in3 months with the first treatment, patients switched to the alternate treatmentfor the next 3 months. The present analysis assessed triptan efficacy in 60subjects with a history of treated or untreated essential arterial hypertension(HT) and in 286 normotensive (NT) subjects. During the study, migraine attackswith aura were significantly more prevalent in HT subjects (21 vs. 13 % NT, p <0.001). The proportion of pain free at 2 h did not significantly differ betweenHTs and NTs for either frovatriptan (25 vs. 26 %) or the comparators (33 vs. 32%). Pain relief was achieved in significantly (p < 0.05) fewer episodes in HTsubjects for both frovatriptan (41 vs. 52 % NT) and the comparators (48 vs. 58%). Relapses at 48 h were similarly low in HTs and NTs with frovatriptan (29 vs. 31 %), while they were significantly (p < 0.05) larger in HTs (62 %) than in NTs (44 %) with comparators. No BP or heart rate increment was observed during thestudy in HT subjects. No difference in tolerability was reported between HTs and NTs. In conclusion, HT individuals tend to be less responsive than NT migraineursto triptan therapy. However, frovatriptan, in contrast to other triptans, seemsto have a sustained antimigraine effect in both HT and NT patients.