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Rapid use of treatment, especially triptans, after headache onset could shorten time from onset to peak, results indicate

Wednesday, July 09 2008 | Comments

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What's This? The use of triptans sooner rather than later after migraine onset is associated with a shorter time from headache onset to headache peak, investigators found. Regardless of treatment timing, triptan use seems to reduce the time from dosing to headache peak relative to use of nontriptan medications.

A research group conducted an observational study to determine whether the timing of treatment could affect the time to headache peak and peak pain severity. They noted that patients in triptan trials are typically instructed to take their study medication only when their headache reaches moderate or severe intensity, thus making it impossible to evaluate the potential effects of dosing earlier in the attack.

This study involved adults with physician-diagnosed migraine who experienced 2 to 8 migraines and ≤15 headache days per month. Patients were given triptans as part of the study, but were encouraged to treat their migraines as they normally would; 182 patients recorded data for 970 migraines during a 30-day period. Of these, 620 migraines were treated before the headache peaked.

The time elapsed from headache onset to peak seemed to be associated with the timing of treatment initiation, according to the study authors. The mean time from headache onset to peak ranged from 1.9 hours among those who initiated treatment <15 minutes after headache onset to 8.9 hours among those who initiated treatment ≥4 hours after headache onset.

In a model adjusted for potential confounders, including headache severity at dosing, recent migraine headache severity, prior attack frequency, and medication class, earlier treatment (<4 hr after headache onset) was associated with a significantly shorter time from headache onset to headache peak as compared with later treatment.

Although later rather than earlier dosing seemed to be associated with a shorter time between dosing and headache peak (1.8 hr among those who initiated treatment <15 minutes after headache onset vs. 0.8 hr among those who waited ≥4 hr), this association was not significant in a model adjusted for potential confounders.

The authors also noted that the use of nontriptan medication was associated with a significantly longer time from headache onset to headache peak (average difference, 1.4 hr) and a significantly longer time from dosing to headache peak as compared with triptan use.

Peak headache severity did not seem to be influenced by the timing of treatment.

"Early intervention during a migraine attack may lead to decreased migraine burden by reducing headache duration," the investigators concluded. (Hu XH, et al. Headache 2008;48:914-920.)

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