Nav: Home

Migraine drugs underused

May 10, 2016

(ABINGTON, PA) - About 38 million Americans suffer from migraines in the United States, according to the Migraine Research Foundation. The most commonly used and effective classes of medication, triptans and DHE (Dihydroergotamine), however, have a black box warning for two subtypes of migraine because of risk of stroke. Now researchers at Abington-Jefferson Health have shown that patients who were given the drugs off-label had no stroke or other cardiovascular side-effects from taking the drugs.

Not only does the study suggest these drugs are safe for this subset of migraine patients, it could also have implications for the nearly 10 million migraine sufferers who experience auras - a disturbance in vision, touch, speech, thinking, or strength that usually precedes a migraine headache.

"There are not enough medicines out there to appropriately manage migraine headaches," says senior author Brad Klein, M.D., Medical Director of the Headache Center at Abington Hospital-Jefferson Health. "At a time in history when an unprecedented number of people are getting hooked on narcotic opiates by way of prescribed medications - as is the case with migraine sufferers as well - we owe it to ourselves as physicians to try medications that could work without the risk of addiction," says Klein. The study was published in the journal Headache.

Migraines are thought to cause pain because they cause a swelling of the blood vessels feeding the brain. However, two subtypes of migraines, basilar and hemiplegic, are thought to cause pain by doing the opposite - constricting rather than swelling the blood vessels of the brain. Triptans and DHE are both thought to relieve migraine, in part, by constricting blood vessels. Early on, drug developers worried that adding more constriction to basilar and hemiplegic migraines could put these patients at greater risk of stroke, so these patients were excluded from the initial studies. "As a result," says Klein, "no one ever actually showed that these drugs were dangerous - they were just assumed to be dangerous based on their mechanism of action. And recent research suggests that the auras are not due to blood vessel constriction."

To determine whether there was any increased risk of stroke in basilar and hemiplegic patients taking triptans or DHE, Klein and researchers at Brigham and Women's Hospital in Boston did a retrospective analysis, collecting data from four headache centers around the country. They searched for patients who had symptoms pointing to a basilar or hemiplegic migraine diagnosis and also received either a triptan or DHE treatment. Of the 80 patients they identified, they saw no cases of stroke or heart attack during the period of routine follow up, over several months.

Although others had studied this effect before, this research had the largest patient cohort to date, and was also one of the first to examine patients treated with DHE.

Migraines can be very complex to diagnose and there are few certified headache specialists in the United States - only 500 for the 38 million sufferers, according to the Migraine Research Foundation. "Because auras are associated with basilar and hemiplegic migraine, many physicians refuse to give these drugs to any patients experiencing an aura out of a false sense of precaution," says Dr. Klein. Instead migraine sufferers may be given other, less effective drugs such as opioid narcotics.
-end-
The authors report no conflicts of interest.

Article reference: P.G. Paul et al., "A retrospective analysis of triptan and dhe use for basilar and hemiplegic migraine," Headache, DOI: 10.1111/head.12804, 2016.

For more information, contact Edyta Zielinska, 215-955-5291, edyta.zielinska@jefferson.edu.

About Jefferson

Our newly formed organization, Jefferson, encompasses Thomas Jefferson University and Jefferson Health, representing our academic and clinical entities. Together, the people of Jefferson, 19,000 strong, provide the highest-quality, compassionate clinical care for patients, educate the health professionals of tomorrow, and discover new treatments and therapies that will define the future of health care.

Jefferson Health comprises five hospitals, 17 outpatient and urgent care locations, as well as physician practices and everywhere we deliver care throughout the city and suburbs across Philadelphia, Montgomery and Bucks Counties in Pa., and Camden County in New Jersey. Together, these facilities serve nearly 73,000 inpatients, 239,000 emergency patients and 1.7 million outpatient visits annually. Thomas Jefferson University Hospital is the largest freestanding academic medical center in Philadelphia. Abington Hospital is the largest community teaching hospital in Montgomery or Bucks counties. Other hospitals include Jefferson Hospital for Neuroscience in Center City Philadelphia; Methodist Hospital in South Philadelphia; and Abington-Lansdale Hospital in Hatfield Township.

Thomas Jefferson University enrolls more than 3,800 future physicians, scientists, nurses and healthcare professionals in the Sidney Kimmel Medical College (SKMC), Jefferson Colleges of Biomedical Sciences, Health Professions, Nursing, Pharmacy, Population Health and is home of the National Cancer Institute (NCI)-designated Sidney Kimmel Cancer Center.

For more information and a complete listing of Jefferson services and locations, visit http://www.jefferson.edu.

Thomas Jefferson University

Related Stroke Articles:

Retraining the brain to see after stroke
A new study out today in Neurology, provides the first evidence that rigorous visual training restores rudimentary sight in patients who went partially blind after suffering a stroke, while patients who did not train continued to get progressively worse.
Catheter ablations reduce risks of stroke in heart patients with stroke history, study finds
Atrial fibrillation patients with a prior history of stroke who undergo catheter ablation to treat the abnormal heart rhythm lower their long-term risk of a recurrent stroke by 50 percent, according to new research from the Intermountain Medical Center Heart Institute.
Imaging stroke risk in 4-D
A new MRI technique developed at Northwestern University detects blood flow velocity to identify who is most at risk for stroke, so they can be treated accordingly.
Biomarkers may help better predict who will have a stroke
People with high levels of four biomarkers in the blood may be more likely to develop a stroke than people with low levels of the biomarkers, according to a study published in the Aug.
Pre-stroke risk factors influence long-term future stroke, dementia risk
If you had heart disease risk factors, such as high blood pressure, before your first stoke, your risk of suffering subsequent strokes and dementia long after your initial stroke may be higher.
Intervention methods of stroke need to focus on prevention for blacks to reduce stroke mortality
Blacks are four times more likely than their white counterparts to die from stroke at age 45.
Study shows area undamaged by stroke remains so, regardless of time stroke is left untreated
A study led by Achala Vagal, M.D., associate professor at the University of Cincinnati College of Medicine and a UC Health radiologist, looked at a group of untreated acute stroke patients and found that there was no evidence of time dependence on damage outcomes for the penumbra, or tissue that is at risk of progressing to dead tissue but is still salvageable if blood flow is returned in a stroke, but rather an association with collateral flow -- or rerouting of blood through clear vessels.
Immediate aspirin after mini-stroke substantially reduces risk of major stroke
Using aspirin urgently could substantially reduce the risk of major strokes in patients who have minor 'warning' events.
SAGE launches the European Stroke Journal with the European Stroke Organisation
SAGE, a world leading independent and academic publisher, is delighted to announce the launch of the European Stroke Journal, the flagship journal of the European Stroke Organisation.
The S-stroke or I-stroke?
The year 2016 is an Olympic year. Developments in high-performance swimwear for swimming continue to advance, along with other areas of scientific research.

Related Stroke Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Don't Fear Math
Why do many of us hate, even fear math? Why are we convinced we're bad at it? This hour, TED speakers explore the myths we tell ourselves and how changing our approach can unlock the beauty of math. Guests include budgeting specialist Phylecia Jones, mathematician and educator Dan Finkel, math teacher Eddie Woo, educator Masha Gershman, and radio personality and eternal math nerd Adam Spencer.
Now Playing: Science for the People

#518 With Genetic Knowledge Comes the Need for Counselling
This week we delve into genetic testing - for yourself and your future children. We speak with Jane Tiller, lawyer and genetic counsellor, about genetic tests that are available to the public, and what to do with the results of these tests. And we talk with Noam Shomron, associate professor at the Sackler School of Medicine at Tel Aviv University, about technological advancements his lab has made in the genetic testing of fetuses.