From the Guidelines
Triptans should not be used in patients with hemiplegic migraine due to potential safety risks. Hemiplegic migraine is a subtype of migraine characterized by temporary weakness on one side of the body during attacks, and the use of triptans in this condition has been traditionally contraindicated 1. The concern stems from triptans' vasoconstrictive properties, which theoretically could increase the risk of stroke in patients who already have neurological symptoms that mimic stroke.
According to the guidelines on the management and prevention of migraines 1, evidence for efficacy is good for various triptans, including orally administered naratriptan, rizatriptan, and zolmitriptan; and orally and subcutaneously administered sumatriptan. However, these guidelines explicitly state that triptans should not be used in patients with basilar or hemiplegic migraine.
Some key points to consider in the management of hemiplegic migraine include:
- Avoiding the use of triptans due to safety concerns
- Considering alternative treatments such as NSAIDs, antiemetics, or preventive medications like calcium channel blockers, antiepileptic drugs, or certain antidepressants
- Working closely with a neurologist to develop an appropriate treatment plan tailored to the patient's specific situation and symptoms.
It is essential to prioritize the patient's safety and consider the potential risks associated with triptan use in hemiplegic migraine, as recommended by the guidelines 1.
From the Research
Efficacy of Triptans in Hemiplegic Migraine
- Triptans can be prescribed for hemiplegic migraine when headaches are not relieved sufficiently with common analgesics, although their use is controversial in this condition 2.
- A study investigating the efficacy, safety, and tolerability of triptans in patients with familial or sporadic hemiplegic migraine found that triptans seem to be safe and effective treatment for most hemiplegic migraine patients 3.
- Another study compared the relative efficacy of triptans for acute treatment of migraines and found that standard dose triptans relieved headaches within 2 hours in 42 to 76% of patients 4.
Safety of Triptans in Hemiplegic Migraine
- The use of triptans in hemiplegic migraine has been a concern due to the potential risk of ischemic vascular events, but a retrospective analysis found no reported acute/subacute ischemic vascular events after the administration of triptans for the abortive treatment of migraines with basilar and hemiplegic-type features 5.
- A study on the treatment of hemiplegic migraine with triptans reported no cases of ischemic stroke or heart attack, but one patient experienced prolonged neurological symptoms related to a single dose of rizatriptan 3.
Comparison with Other Treatments
- Triptans are effective for migraine relief and are associated with better outcomes than ergots, and most triptans are associated with equal or better outcomes compared with NSAIDs, ASA, and acetaminophen 4.
- Anti-epileptic drugs, such as topiramate and valproate, are effective for the preventive treatment of migraine, but may have serious side effects and are not recommended for women of childbearing potential 6.