The nausea of a Migraine attack can be the enemy of the migraineur trying to take oral medications. This is a big issue. The nausea can limit how effective our oral acute medications are by causing us to delay or avoid taking medications and by reducing the absorption of the medications because of vomiting. This has left us with a Catch-22 Many of the same medications that are difficult to impossible to use due to nausea would actually help reduce the nausea, IF we could take them and keep them down.
The nausea of migraine is one reason that some of the triptans, the most often used migraine abortive medications, are also available in nasal spray and subcutaneous injection forms. Problems remain for some migraineurs, even with the nasal sprays and injections. Some people find it difficult to self-inject. Many migraineurs found that the nasal sprays dripped down their throats, making the nausea worse.
To address the issue of nausea creating problems with acute Migraine medications, researchers began looking at transdermal (delivered through the skin) form of sumatriptan. A study comparing oral and transdermal delivery was quite positive.
Study Objective: “To evaluate the efficacy and safety of transdermal sumatriptan in migraine patients who have baseline nausea.”
- This was a multicenter, randomized, double-blind, placebo-controlled study.
- Study participant ages ranged from 18 to 66.
- 530 study participants were randomized to receive transdermal sumatriptan or a placebo patch
- Participants remained in the study until they had treated a single moderate to severe migraine attack or had gone 2 months without treatment.
- Before applying the study patch (baseline), participants recorded headache intensity and the presence or absence of migraine-associated symptoms,
- The use of analgesic or anti-emetic (anti-nausea) rescue medications within 2 hours of patch activation was prohibited.
- Study data was analyzed to assess the proportion of patients with nausea at baseline who, at one and two hours after activating the patch, experienced
- A total of 454 patients were included in the intent-to-treat population for efficacy analyses.
- Baseline demographic and migraine characteristics were generally similar between the sumatriptan and placebo groups.
- Overall, transdermal sumatriptan was significantly superior to placebo:
- at 1 hour post-activation for pain relief (29% vs. 19%, respectively);
- at 1 hour post-activation for freedom from nausea (71% vs. 58%, respectively);
- at 2 hours post-activation for freedom from pain (18% vs. 9%, respectively)
- at 2 hours post-activation for pain relief (53% vs. 29%, respectively)
- at 2 hours post-activation for freedom from nausea (84% vs.
- at 2 hours post-activation for freedom from photophobia (51% vs. 36%, respectively),
- at 2 hours post-activation for freedom from phonophobia (55% vs. 39%, respectively);
- at 2 hours post-activation for freedom from migraine (16% vs. 8%, respectively).
- In the follow-up analysis, transdermal sumatriptan was markedly superior to placebo for pain relief and freedom from pain, nausea, photo-, and phonophobia at 1 and 2 hours post-activation.
“Transdermal sumatriptan is superior to oral triptans for migraine patients whose baseline nausea causes them to delay or avoid acute treatment.”
Summary and Comments:
A bit of information about transdermal sumatriptan: The transdermal sumatriptan patch is significantly larger than most transdermal patches because the sumatriptan molecule is too large to pass through the skin on its own. The sumatriptan patch employs a process called iontophoresis, which is a non-invasive method for transporting a molecule through the skin by means of a mild electrical current. The electrical current carries the charged molecule from the patch across the skin. Once across, the drug is rapidly absorbed and distributed systemically.
There is a transdermal sumatriptan patch that has been approved by the FDA, Zecuity. Don’t let the name confuse you. At one point, the planned name for this patch was Zelrix. It should be available soon and will be a welcome new tool for migraineurs who can use sumatriptan but whose use of it is deterred by nausea.
Schulman, Elliot A., MD. “Transdermal Sumatriptan for Acute Treatment of Migraineurs With Baseline Nausea.” Headache 2012;52:204-212.
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Teri Robert is a leading patient educator and advocate and the author of Living Well with Migraine Disease and Headaches. A co-founder of the Alliance for Headache Disorders Advocacy and the American Headache and Migraine Association, she received the National Headache Foundation’s Patient Partners Award and a Distinguished Service Award from the American Headache Society. Teri can be found on her website, and blog, Facebook, Twitter, StumbleUpon, Pinterest, LinkedIn, and Google+.