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Revisiting the Efficacy of Sumatriptan Therapy During the Aura Phase of Migraine

Authors

  • Sheena K. Aurora MD,

    1. From the Swedish Medical Center, Seattle, WA, USA (S.K. Aurora and P.M. Barrodale); GlaxoSmithKline, Research Triangle Park, NC, USA (S.A. McDonald); Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA (M. Jakubowski and R. Burstein); Program in Neuroscience, Harvard Medical School, Boston, MA, USA (R. Burstein).
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  • Patricia M. Barrodale RN,

    1. From the Swedish Medical Center, Seattle, WA, USA (S.K. Aurora and P.M. Barrodale); GlaxoSmithKline, Research Triangle Park, NC, USA (S.A. McDonald); Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA (M. Jakubowski and R. Burstein); Program in Neuroscience, Harvard Medical School, Boston, MA, USA (R. Burstein).
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  • Susan A. McDonald MA,

    1. From the Swedish Medical Center, Seattle, WA, USA (S.K. Aurora and P.M. Barrodale); GlaxoSmithKline, Research Triangle Park, NC, USA (S.A. McDonald); Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA (M. Jakubowski and R. Burstein); Program in Neuroscience, Harvard Medical School, Boston, MA, USA (R. Burstein).
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  • Moshe Jakubowski PhD,

    1. From the Swedish Medical Center, Seattle, WA, USA (S.K. Aurora and P.M. Barrodale); GlaxoSmithKline, Research Triangle Park, NC, USA (S.A. McDonald); Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA (M. Jakubowski and R. Burstein); Program in Neuroscience, Harvard Medical School, Boston, MA, USA (R. Burstein).
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  • Rami Burstein PhD

    1. From the Swedish Medical Center, Seattle, WA, USA (S.K. Aurora and P.M. Barrodale); GlaxoSmithKline, Research Triangle Park, NC, USA (S.A. McDonald); Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA (M. Jakubowski and R. Burstein); Program in Neuroscience, Harvard Medical School, Boston, MA, USA (R. Burstein).
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  • Financial support: The study was funded by GlaxoSmithKline (GSK).

  • Conflict of Interest: Dr. Aurora serves as a consultant to GSK. Dr. Burstein received grant support for basic research studies from GSK. Dr. MacDonald is an employee of GSK.

R. Burstein, Center for Life Science, Room 649, 3 Blackfan Circle, Boston, MA 02215, USA.

Abstract

Objective.— To reexamine the efficacy of terminating migraine headache by administration of sumatriptan during the visual-aura phase of the attack.

Background.— Although the antimigraine action of triptans is most effective soon after onset of the headache, treatment during the aura phase has been found to be ineffective.

Methods.— Nineteen subjects having migraine with aura were studied using a 4-way crossover, open-label design. Each patient was asked to treat 8 consecutive attacks with 100 mg of sumatriptan RT: 3 attacks treated at a timing of the patient's discretion (baseline); 1 attack treated 4 hours after onset of pain (late); 2 attacks treated within 1 hour of onset of pain (early); 2 attacks treated during the aura phase – before the onset of pain (aura). Pain level and cutaneous allodynia were reported by the patients at the onset of pain, at the time of treatment, and 2 and 24 hours after treatment.

Results.— Sumatriptan treatment during the aura preempted the development of headache in 34/38 (89%) attacks. The same patients were rendered pain-free in 30/38 (79%) of attacks treated within 1 hour of pain onset, and in 4/19 (21%) of attacks treated 4 hours after the onset of pain. The incidence of allodynia at the time of treatment was 2/38 (5%) in attacks treated during aura, 8/38 (21%) in attacks treated early, and 14/19 (74%) in attacks treated late.

Conclusion.— Considering the discrepancy between the present and previous clinical studies, it is worthwhile revisiting the efficacy of preemptive triptan therapy during the aura phase of migraine attacks, using larger-scale, 3-way, crossover, placebo-controlled studies.

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