Conflict of Interest: Consultant for NuPathe, speaker's bureau for Allergan, MAP, Nautilus and Zogenix, royalty with Oxford University Press and Springer, grants with Allergan and NuPathe.
Why Triptan Treatment Can Fail: Focus on Gastrointestinal Manifestations of Migraine
Article first published online: 30 MAY 2013
© 2013 American Headache Society
Headache: The Journal of Head and Face Pain
Special Issue: Migraine and Gastrointestinal Manifestations – Treatment Challenges
Volume 53, Issue Supplement S1, pages 11–16, June 2013
How to Cite
Newman, L. C. (2013), Why Triptan Treatment Can Fail: Focus on Gastrointestinal Manifestations of Migraine. Headache: The Journal of Head and Face Pain, 53: 11–16. doi: 10.1111/head.12111
- Issue published online: 30 MAY 2013
- Article first published online: 30 MAY 2013
- Manuscript Accepted: 5 MAR 2013
- NuPathe Inc
- 5-hydroxytryptamine1B/1D agonist;
Results of randomized, double-blind, controlled studies establish the efficacy of triptans in the acute treatment of migraine, but triptan benefits demonstrated in clinical trials have not consistently been realized in clinical practice. This paper explores the contribution of gastrointestinal manifestations of migraine – namely nausea (with or without vomiting) and gastroparesis – to triptan treatment failure.
Migraine-related nausea and vomiting and migraine-associated gastroparesis appear to be prevalent and highly impactful and have been characterized as being among the greatest challenges affecting migraine care today. These gastrointestinal signs and symptoms have not been satisfactorily taken into account in the management of migraine, which is dominated by the use of oral therapies. Oral triptans are not the optimal therapy in the presence of migraine-related nausea because nausea predicts poor response to oral triptans and because nausea can cause patients to delay oral treatment, which can further compromise therapeutic efficacy. Oral triptans are not the optimal therapy in the presence of migraine-associated gastroparesis because these agents rely on gastric motility and gastrointestinal absorption and may be ineffective or slowly or inconsistently effective in the presence of gastroparesis. Health care providers need to work with their patients to address the still-all-too-frequent problem of treatment failure in migraine. First, health care providers need to have greater appreciation of the importance of nausea, vomiting, and gastroparesis as factors affecting migraine prognosis and treatment success. Second, health care providers need to systematically assess migraine patients for gastrointestinal signs and symptoms. Finally, patients and health care providers need to be willing to practice customized migraine care, in which patients tailor the treatment and formulation to the characteristics and context of the individual migraine episode.