Treatment-emergent CNS symptoms following triptan therapy are part of the attack

P. J. Goadsby, D. W. Dodick, M. Almas, H. C. Diener, P. Tfelt-Hansen, Richard B. Lipton, B. Parsons

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

If treatment-emergent central nervous system (CNS) symptoms following triptan therapy represent direct pharmacological effects of the drug, they should occur independent of response to active drug. However, if they represent unmasking of neurological symptoms of the migraine attack after pain is relieved, they should be more common in responders both to active drug and to placebo. To explore this issue, we evaluated the relationship between the CNS adverse events and treatment response following triptan or placebo treatment. We used pooled data from seven double-blind, placebo-controlled trials involving eletriptan 20 mg (E20, n = 402), eletriptan 40 mg (E40, n = 1870), eletriptan 80 mg (E80, n = 1393), sumatriptan 100 mg (S100, n = 275) and placebo (Pbo, n = 1024). Somnolence was more prevalent among 2 h headache responders than non-responders for all treatments, including E80 (8.8% vs. 5.0%; P < 0.05), E40 (6.4% vs. 5.0%; NS), E20 (4.0% vs. 2.0%; NS), S100 (4.7% vs. 3.2%; NS) and Pbo (7.6% vs. 3.0%; P < 0.05). Similarly, the incidence of asthenia was higher among patients who responded to treatment compared with those who did not respond to E80 (15.2% vs. 7.8%; P < 0.05), E40 (6.5% vs. 3.6%; P < 0.05), E20 (6.5% vs. 1.0%; P < 0.05), S100 (10.1% vs. 4.7%; NS) and Pbo (4.4% vs. 2.7%; NS). The generally higher rates of somnolence and asthenia in patients who respond to treatment suggests that these treatment-emergent neurological symptoms may represent the unmasking of CNS symptoms associated with the natural resolution of a migraine attack, rather than simply representing drug-related side-effects. The rate of somnolence in placebo responders is comparable to that in responders to E40 and E80, indicating that somnolence is related, at least in some important part, to headache relief and not treatment.

Original languageEnglish (US)
Pages (from-to)254-262
Number of pages9
JournalCephalalgia
Volume27
Issue number3
DOIs
StatePublished - Mar 2007

Fingerprint

Tryptamines
Central Nervous System
Placebos
Asthenia
Therapeutics
Migraine Disorders
Headache
Pharmaceutical Preparations
Sumatriptan
Drug-Related Side Effects and Adverse Reactions
Pharmacology
Pain

Keywords

  • Adverse events
  • Eletriptan
  • Migraine

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Goadsby, P. J., Dodick, D. W., Almas, M., Diener, H. C., Tfelt-Hansen, P., Lipton, R. B., & Parsons, B. (2007). Treatment-emergent CNS symptoms following triptan therapy are part of the attack. Cephalalgia, 27(3), 254-262. https://doi.org/10.1111/j.1468-2982.2007.01278.x

Treatment-emergent CNS symptoms following triptan therapy are part of the attack. / Goadsby, P. J.; Dodick, D. W.; Almas, M.; Diener, H. C.; Tfelt-Hansen, P.; Lipton, Richard B.; Parsons, B.

In: Cephalalgia, Vol. 27, No. 3, 03.2007, p. 254-262.

Research output: Contribution to journalArticle

Goadsby, PJ, Dodick, DW, Almas, M, Diener, HC, Tfelt-Hansen, P, Lipton, RB & Parsons, B 2007, 'Treatment-emergent CNS symptoms following triptan therapy are part of the attack', Cephalalgia, vol. 27, no. 3, pp. 254-262. https://doi.org/10.1111/j.1468-2982.2007.01278.x
Goadsby, P. J. ; Dodick, D. W. ; Almas, M. ; Diener, H. C. ; Tfelt-Hansen, P. ; Lipton, Richard B. ; Parsons, B. / Treatment-emergent CNS symptoms following triptan therapy are part of the attack. In: Cephalalgia. 2007 ; Vol. 27, No. 3. pp. 254-262.
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