Sumatriptan: Pharmacological Basis and Clinical Results

Carl G. H. Dahlöf

Disclosures

Curr Med Res Opin. 2001;17(1s) 

In This Article

Special Migraine Conditions

In addition to demonstrating efficacy in typical migraine attacks, sumatriptan is effective in migraine types, such as menstrual migraine and early-morning migraine, that have been characterized as being more difficult to treat. Sumatriptan injection was determined several years ago to be as effective for earlymorning migraine as it is for migraine occurring during other times of the day. Across two attacks, headache relief 2 h post-dose was reported by 73-78% of patients using sumatriptan injection for early-morning migraine compared with 20-28% of placebo- treated patients[35].

Similarly, both sumatriptan injection and sumatriptan tablets are effective in menstrual migraine[36]. In a retrospective analysis of data from two sumatriptan injection trials, for example, 80% of women treating menstrual migraines (defined as migraine beginning 1-4 days from the onset of menstrual flow) compared with 19% of placebo-treated patients reported headache relief 2 h after dosing[36]. These results were similar to those from the patients in the same trials with non-menstrual migraine: 70% of women using sumatriptan injection compared with 19% of placebo-treated patients reported headache relief. In a prospective study of sumatriptan tablets 100 mg, headache relief 4 h post-dose for migraine attacks occurring inside the menstrual window (defined as the 8 days commencing 3 days prior to the onset of menstruation) was reported by 67% of sumatriptan-treated patients compared with 33% of placebo-treated patients[36]. For attacks occurring outside the menstrual window, headache relief 4 h post-dose was reported by 79% of sumatriptantreated patients compared with 31% of placebotreated patients.

Sumatriptan injection is also effective in cluster headache, characterized by recurrent, extremely severe, often unilateral headaches that occur in bouts. In a study reported in The New England Journal of Medicine, sumatriptan injection alleviated cluster headache pain within 15 min of injection in 74% of attacks compared with 26% of attacks with placebo[37]. Freedom from pain was conferred within 10 min of sumatriptan injection in 36% of patients compared with 3% with placebo. Similar results were obtained in a second study[38]. Although sumatriptan injection effectively alleviates cluster headaches when administered during the attack, it has been found not to be effective as a pre-emptive treatment for cluster headaches[39]. The 20 mg nasal spray generally is not strongly effective in cluster headache[40].

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