Many migraineurs who have _ hemiplegic migraine_ and migraine with brainstem aura (formerly called _ basilar-type migraine) face a truly confounding predicament regarding migraine _ abortive medications. The prescribing information for the triptans (Imitrex, Maxalt, Zomig, etc.), which are the the most recommended first-line treatment for migraine attacks contain a contraindication that states they shouldn’t be prescribed for patients with hemiplegic or migraine with brainstem aura. That contraindication comes from a concern about their vasoconstrictive actions because triptans haven’t been extensively studied for those forms of migraine.
At the 56th Annual Scientific Meeting of the American Headache Society, held in June of 2014, a study reported in a research poster presented a somewhat different view of triptan use by patients with hemiplegic migraine and migraine with brainstem aura.
“Evaluating efficacy and tolerability of triptans in basilar and hemiplegic migraines.”
- A retrospective review of patient charts was conducted at two migraine and headache specialty care institutions by searching electronic databases with data from 2007-2013.
- Searchable terms included:
- basilar migraine,
- facial droop,
- altered consciousness,
- aphasia, and
- all of the triptans.
- The study included 39 patients:
- Of the 39 patients, 36 had a diagnosis of migraine with brainstem aura, and three had a diagnosis of hemiplegic migraine.
- No strokes or myocardial infarctions (heart attacks) were reported as side effects of triptans.
- Five patients reported adverse effects, including:
- GI upset,
- neck dystonia,
- nightmares, and
“In this retrospective study, triptans were used effectively with no subsequent vascular events for the abortive treatment of migraines with basilar and hemiplegic features. This data also suggests that beta blockers, tricyclic anti-depressants, anti-convulsants, and Botox injections have some efficacy in the treatment of migraines with basilar type and hemiplegic features.”
Summary and comments:
Is it safe to take triptans for hemiplegic migraine or migraine with brainstem aura? That’s a question for which there isn’t, at least at this time, a single safe, definitive answer. Given the needs of patients for effective abortive treatment and the paucity of reliable information about the use of triptans for these migraine types, a larger retrospective study is definitely needed. The data from this retrospective study, however, is information that patients and doctors can evaluate together when selecting treatment options.
Krel, R.; Mathew, P.G.; Spinner, D.; Joshi, S. “Spinning Out of Control: The Black Box of Basilar and Hemiplegic Migraine.” Poster Presentation. 56th Annual Scientific Meeting; American Headache Society. Los Angeles. June, 2014.
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_Reviewed by David Watson, MD. _
© Teri Robert, 2014, - Last updated July 14, 2014.
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+.