Predictors of migraine headache recurrence: A pooled analysis from the eletriptan database

David W. Dodick, Richard B. Lipton, Peter J. Goadsby, Peer Tfelt-Hansen, Michel D. Ferrari, Hans Christoph Diener, Mary Almas, Kenneth S. Albert, Bruce Parsons

Research output: Contribution to journalArticle

21 Scopus citations

Abstract

Objective. - To identify clinical variables associated with risk of headache recurrence within 22 hours of initial successful treatment of a migraine attack (2-hour headache response), and to analyze the effect of eletriptan in reducing the incidence of recurrence. Methods. - Data were pooled from 10 randomized, double-blind, placebo-controlled trials evaluating eletriptan 40 mg (E40), eletriptan 80 mg (E80), and sumatriptan 100 mg (S100) for acute migraine treatment. Patients who achieved a headache response (improvement from moderate/severe pain at baseline to mild/no pain at 2 hours postdose) were evaluable. A multivariable logistic regression analysis identified significant predictors of headache recurrence (return to moderate/severe pain intensity within 22 hours of initial headache response). Treatment response was assessed in two high-risk subgroups, defined by the presence of significant recurrence predictors. Results. - Of 4312 patients responding to acute treatment within 2 hours postdose, 1232 (29%) experienced recurrence. Initial headache response within 2 hours was significantly higher for E40 (62.0%), E80 (67.4%), and S100 (57.9%) compared to placebo (25.1%; all P <.0001). Three clinical variables were significant predictors of recurrence: female gender, age ≥35 years, and severe baseline headache pain. Among patients with all 3 risk factors (n = 742; 17% of total population), recurrence rates were lower with E40 (35.6%) and E80 (32.9%) than placebo (47.8% P <.01). The same result was observed in the subgroup of patients with 2 risk factors (female gender and age ≥35 years; P <.0001 vs placebo). Sustained headache and pain-free response rates (a headache/pain-free response at 2 hours postdose with no headache recurrence and no rescue medication use in the subsequent 22 hours) were significantly higher with E40 and E80 than placebo in both high-risk subgroups (P <.05). Conclusion. - Female gender, age ≥35 years, and severe baseline headache pain are significant predictors of headache recurrence during a migraine attack. Eletriptan is effective at reducing the incidence of headache recurrence in high-risk subgroups.

Original languageEnglish (US)
Pages (from-to)184-193
Number of pages10
JournalHeadache
Volume48
Issue number2
DOIs
StatePublished - Feb 1 2008

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Keywords

  • Eletriptan
  • Predictors
  • Recurrence

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Dodick, D. W., Lipton, R. B., Goadsby, P. J., Tfelt-Hansen, P., Ferrari, M. D., Diener, H. C., Almas, M., Albert, K. S., & Parsons, B. (2008). Predictors of migraine headache recurrence: A pooled analysis from the eletriptan database. Headache, 48(2), 184-193. https://doi.org/10.1111/j.1526-4610.2007.00868.x