Magazine article Clinical Psychiatry News

Guidelines Call Triptans Key Part of Migraine Tx. (Half of Patients Respond to NSAIDS)

Magazine article Clinical Psychiatry News

Guidelines Call Triptans Key Part of Migraine Tx. (Half of Patients Respond to NSAIDS)

Article excerpt

PHILADELPHIA -- The triptans are the cornerstone of treatment for patients with moderate to severe migraine headaches in the new management guidelines of the American College of Physicians-American Society of Internal Medicine.

The ACP-ASIM guidelines, which will appear later this year in the Annals of Internal Medicine, were adapted from guidelines issued in 2000 by the American Academy of Neurology, Dr. Eric M. Wall said at the annual meeting of the ACP-ASIM. The ACP-ASIM version was designed to be clearer and more user friendly, said Dr. Wall, medical director of LifeWise, a health insurance company based in Portland, Ore.

The ACP-ASIM guidelines list NSAIDs--including aspirin, ibuprofen, and naproxen--as the first-line treatment for a patient with migraine headaches. About half of patients with migraine headaches will respond to treatment with NSAIDs, said Dr. David B. Matchar, director of the Duke Center for Clinical Health Policy Research in Durham, N.C. But physicians often find NSAIDs of limited value because most patients with migraines who seek medical help have already tried and failed self-medication with one or more NSAIDs. This means that the triptans are the best option for many patients who consult a physician about migraine headaches.

Five triptans are currently on the U.S. market: almotriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan. All five drugs seem equally safe and effective, and there is little basis for choosing among them, Dr. Matchar said. About two-thirds of patients can expect to have a positive response to triptan treatment.

The claims by certain manufacturers that some of these drugs have longer serum half-lives and therefore are more effective at preventing migraine headaches have not been proven by available clinical evidence, he said. What is clear, however, is that if one triptan is not effective for a patient, another may be. …

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