Taking Triptans During Migraine Aura May Work Better

Patient Expert

Taking Triptans During Migraine Aura May Work Better

It's confusing. Some doctors tell us to take Migraine abortive medications such as the triptans early in a Migraine attack -- during the aura if you get auras. Others say triptans won't work taken that early, to wait for the headache phase to begin.

So, for those of us with Migraine with aura, when IS it best to take triptans? When the aura starts? When the pain starts? Does it even make a difference.

Aurora et. al. set out to take a look at those very question. The objective of their study was

"To reexamine the efficacy of terminating migraine headache by administration of sumatriptan during the visual-aura phase of the attack."

Previous studies have been conflicting and confusing. It has been shown that taking triptans early in the headache phase of a Migraine attack, while the pain is mild and allodynia has not fully developed, increases the success rate of triptans for giving pain-free relief. However, previous data had also shown that taking triptans during the aura phase did not abort the Migraine before the beginning of the headache phase. Given the length of time triptans remain active and effective in the body, it would seem that triptans taken during the aura phase should work better than reported. Because patients have been telling doctors how effective triptans are for them when taken during the aura phase, Aura et. al. decided to do a study comparing the effects of sumatriptan taken during aura phase, before the beginning of pain, and the effects when taken after the pain begins.

Study methods:

  • There were 32 patients with Migraine with aura (MWA) originally recruited for the study; 19 completed it.

  • Patients could be taking no more than one preventive medication.

  • Patients maintained a detailed Migraine diary electronically. It was updated and sent via the Internet or by paper copy.

  • Patients were asked to treat a total of eight consecutive Migraine attacks with 100 mg of sumatriptan.

    • For the first three attacks, patients treated at a time left to their judgment.

    • One attack was treated four hours after the aura began (late).

    • Two attacks were treated within one hour of one hour of the pain beginning (early).

    • Two attacks were treated during the aura phase, before the beginning of pain.

  • Patients recorded and reported pain levels and the presence of cutaneous allodynia (a condition in which an ordinarily painless stimulus is experienced as being painful) at four times:

  • When pain began.

  • When sumatriptan was taken.

  • Two hours after taking sumatriptan.

  • Four hours after taking sumatriptan.

Allodynia questionnaire:

Patients were asked if they experienced pain or unpleasant sensation on their skin during a Migraine attack when they engaged in the activities below. They were to answer "Yes," "No," or "Not Applicable"

  1. combing your hair

  2. pulling your hair back (example: ponytail);

  3. shaving your face;

  4. wearing eyeglasses;

  5. wearing contact lenses;

  6. wearing earrings;

  7. wearing necklaces;

  8. wearing anything tight on your head or neck (hat, scarf);

  9. wearing anything on your arm or wrist (bracelet, watch);

  10. wearing a finger ring;

  11. wearing tight clothes;

  12. being covered with a heavy blanket;

  13. taking a shower (when water hits your face);

  14. resting your face on the pillow on the side of the headache;

  15. being exposed to heat (examples: cooking; placing heating pads on your face);

  16. being exposed to cold (examples: breathing through your nose on a cold day; placing ice packs on your face).

Study endpoints: (Overall outcome that the protocol is designed to evaluate):

  • Primary: pain-free status two hours after taking sumatriptan.

  • Secondary: sustained pain-free status through 24 hours.

Study results:

  • Sumatriptan taken during the aura phase stopped the Migraine attack before the headache phase in 34/38 (89%) of attacks.

  • The same patients were pain-free in 30/38 (79%) of attacks in which sumatriptan was taken within 1 hour of pain onset

  • The same patients were pain-free in 4/19 (21%) of attacks in which sumatriptan was taken 4 hours after the onset of pain.

  • Allodynia occurred at the time of taking the sumatriptan in 2/38 (5%) in attacks treated during aura.

  • Allodynia occurred at the time of taking the sumatriptan in 8/38 (21%) in attacks treated within one hour of pain beginning (early).

  • Allodynia occurred at the time of taking the sumatriptan in 14/19 (74%) in attacks treated four hours after the aura began (late).

Summary and comments:

The results of this study are good news for Migraineurs who have Migraine with aura. Certainly, if we can abort the Migraine attack during the aura phase, before the headache phase begins, it will reduce our tine living in pain and other debilitating Migraine symptoms. It would also make sense that it would be healthier and easier on our bodies if we can cut Migraine attacks short.

This was an intentionally small study designed to see if larger studies are warranted. I believe they are, and certainly Aurora et. al. do as well. They wrote:

Treating migraine with sumatriptan within the first 15 minutes of the aura phase proved extremely effective in preempting the onset of migraine headache. Our findings stand in contrast with previous studies, in which treatment with triptans was ineffective during the aura phase of migraine.2-4 In view of this discrepancy, we would like to urge other groups to revisit the efficacy of triptans during the aura phase of migraine using larger-scale, 3-way, crossover, placebo-controlled studies.

On a personal note, I'm thrilled with the results of this trial. My personal experience is that taking a triptan during the aura phase of my Migraines often does indeed abort the Migraine before the headache phase begins. Quality of both health and life are improved when Migraines take less out of me and my life. It will be intriguing to watch for larger studies on this issue, especially if more of the triptans are tested in this way. Of course, the majority of Migraineurs do not experience aura, and it may not work all the time. Still, this could be very valuable research.


Resources:

Aurora, Sheena K., MD; Barrodale, Patricka M., RN; McDonald, Susan A., MA; Jakubowski, Moshe, PhD; Brustein, Rami, PhD. "Revisiting the Efficacy of Sumatriptan Therapy During the Aura Phase of Migraine." Headache: The Journal of Head and Face Pain (Early View). 2009. doi: 10.1111/j.1526-4610.2009.01429.x