From the Guidelines
For a patient with angina, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-600mg every 6-8 hours) or naproxen sodium (500mg initially, then 250mg every 6-8 hours) are the most effective and safest options for treating migraines, as they pose less cardiovascular risk compared to triptans 1.
Key Considerations
- NSAIDs are recommended as first-line treatment for migraines in patients with angina, due to their efficacy and relatively lower cardiovascular risk 1.
- Acetaminophen (1000mg every 6 hours, not exceeding 4000mg daily) is another option that does not affect the cardiovascular system, but its efficacy as a standalone treatment for migraines is lower compared to NSAIDs 1.
- Triptans (like sumatriptan) and ergotamines should typically be avoided in patients with angina, as they can constrict blood vessels and potentially worsen cardiac issues 1.
Additional Recommendations
- It is crucial to consult with a healthcare provider before taking any migraine medication if you have chest pain, as the pain could indicate a cardiovascular condition that might be worsened by certain migraine treatments 1.
- The chest pain should be evaluated by a healthcare provider to determine its cause before starting any migraine treatment 1.
- Combining medication with non-pharmacological approaches, such as resting in a dark, quiet room, applying cold compresses, and practicing stress management techniques, may be beneficial for managing migraines in patients with angina 1.
From the FDA Drug Label
The use of sumatriptan tablets is contraindicated in patients with ischemic or vasospastic CAD. Eletriptan hydrobromide is contraindicated in patients with ischemic or vasospastic CAD.
The FDA drug label does not answer the question.
From the Research
Migraine Medication for Patients with Angina
- The most effective migraine medication for a patient with angina is not explicitly stated in the provided studies, but some medications are contraindicated in patients with ischemic heart disease or angina 2.
- Triptans, such as sumatriptan, are effective in treating migraine but may be contraindicated in patients with angina due to the risk of myocardial ischemia 2, 3.
- Eletriptan is a highly selective serotonin 5-HT(1B/1D) receptor agonist that is effective in the acute treatment of moderate to severe migraine attacks, but its safety in patients with angina is not explicitly stated 4.
- Metoclopramide was effective in resolving symptoms, including chest pain, in patients with migraine and chest pain 5.
Considerations for Patients with Angina
- Patients with angina should be cautious when taking triptans, such as sumatriptan, due to the risk of myocardial ischemia 2, 3.
- The treatment of migraine in patients with angina should focus on controlling migraine symptoms while minimizing the risk of exacerbating angina 5.
- Other medications, such as acetaminophen and nonsteroidal anti-inflammatory drugs, may be considered as first-line treatments for mild to moderate migraines in patients with angina 6.