Pascual Julio, Cabarrocas Xavier
Service of Neurology, University Hospital Marqués de Valdecilla, Santander, Spain.
Headache. 2002 Jan;42(1):28-31. doi: 10.1046/j.1526-4610.2002.02010.x.
Migraine sufferers typically have been instructed to delay triptan therapy until headache intensity is at least moderate. Recent data suggest that earlier use of triptans may be more beneficial.
To address the potential "within-patient" benefit of intervention with almotriptan 12.5 mg for migraine headache of mild intensity.
We performed a post hoc analysis of a subgroup of patients from a large, open-label, long-term clinical trial wherein 762 migraineurs used almotriptan 12.5 mg for headache attacks of any severity. Specifically, we evaluated the efficacy and safety of treatment in those patients who had treated at least 3 "mild" attacks and 3 "moderate/severe" attacks, examining rates of pain-free status, use of rescue medication, early recurrence, and adverse events for the first 3 mild and the first 3 moderate/severe attacks treated.
There were 118 migraineurs and 708 attacks available for analysis. At 1 hour following treatment, pain-free status was achieved in 47% of mild attacks versus 14% of moderate/severe attacks (P<.001); incidences at 2 hours were 84% of mild attacks and 53% of moderate/severe attacks (P<.001). The chance of achieving pain-free status at 1 hour in at least 2 of 3 treated attacks was 45% for mild attacks and 9% for moderate/severe attacks; at 2 hours the percentages were 88% for mild attacks and 56% for moderate/severe attacks. Rescue medication was required in 8% of mild attacks and in 13% of moderate/severe attacks (P<.01). The incidence of early recurrence was 28% for mild attacks and 33% for moderate/severe attacks (P<.01). There was no difference in the incidence of adverse events for mild versus moderate/severe attacks (6% versus 7%).
These results support early intervention with oral triptan therapy. When used for mild intensity head pain, almotriptan 12.5 mg produced a significantly higher incidence of pain-free status at 1 and 2 hours and lower incidences of early headache recurrence or need for rescue medication.
偏头痛患者通常被指示推迟使用曲坦类药物治疗，直到头痛强度至少为中度。最近的数据表明，更早使用曲坦类药物可能更有益。
探讨使用12.5毫克阿莫曲坦干预轻度偏头痛的潜在“患者内”益处。
我们对一项大型、开放标签、长期临床试验的患者亚组进行了事后分析，其中762名偏头痛患者使用12.5毫克阿莫曲坦治疗任何严重程度的头痛发作。具体而言，我们评估了那些至少治疗过3次“轻度”发作和3次“中度/重度”发作的患者的治疗效果和安全性，检查了首次治疗的前3次轻度发作和前3次中度/重度发作的无痛状态率、急救药物使用情况、早期复发情况和不良事件。
有118名偏头痛患者和708次发作可供分析。治疗后1小时，47%的轻度发作达到无痛状态，而中度/重度发作仅为14%（P<0.001）；2小时时，轻度发作的发生率为84%，中度/重度发作的发生率为53%（P<0.001）。在治疗的3次发作中，至少有2次在1小时达到无痛状态的几率，轻度发作为45%，中度/重度发作为9%；2小时时，轻度发作的百分比为88%，中度/重度发作的百分比为56%。8%的轻度发作需要使用急救药物，中度/重度发作的这一比例为13%（P<0.01）。轻度发作的早期复发率为28%，中度/重度发作的早期复发率为33%（P<0.01）。轻度发作和中度/重度发作的不良事件发生率无差异（分别为6%和7%）。
这些结果支持早期口服曲坦类药物治疗。当用于轻度头痛时，12.5毫克阿莫曲坦在1小时和2小时时产生无痛状态的发生率显著更高，早期头痛复发或需要使用急救药物的发生率更低。
