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Frovatriptan as Preemptive Treatment for Fasting-Induced Migraine

Authors

  • Meryl Latsko MD, MPH,

    1. From the Thomas Jefferson University—Neurology/Headache, Jefferson Headache Center, Philadelphia, PA, USA (M. Latsko and S. Silberstein); Albert Einstein University—Neurology/Headache, New York, NY, USA (N. Rosen).
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  • Stephen Silberstein MD,

    1. From the Thomas Jefferson University—Neurology/Headache, Jefferson Headache Center, Philadelphia, PA, USA (M. Latsko and S. Silberstein); Albert Einstein University—Neurology/Headache, New York, NY, USA (N. Rosen).
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  • Noah Rosen MD

    1. From the Thomas Jefferson University—Neurology/Headache, Jefferson Headache Center, Philadelphia, PA, USA (M. Latsko and S. Silberstein); Albert Einstein University—Neurology/Headache, New York, NY, USA (N. Rosen).
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  • Conflict of Interest: Dr. Silberstein, MD, is on the speakers' bureau of and receives honoraria from Endo Pharmaceuticals. His employer receives research support from Endo Pharmaceuticals. Dr. Latsko, MD, MPH, has no personal conflict of interest. Her employer receives research support from Endo Pharmaceuticals. Dr. Rosen, MD, has no conflicts of interest.

M. Latsko, Jefferson Headache Center 111 S. 11th Street, Philadelphia, PA 19107, USA.

Abstract

Objective.— To examine frovatriptan's efficacy as preemptive treatment for fasting-induced migraine.

Background.— Fasting is a common migraine trigger that cannot always be avoided. The development of a short-term preemptive approach would be of benefit. Because of its longer half-life, frovatriptan has been effectively used for short-term daily use to prevent menstrually related migraines and might prove useful in the prevention of fasting-induced migraine.

Methods.— This was a double-blind, placebo-controlled, randomized, parallel-group trial.

Subjects.— With a history of fasting-induced episodic migraine were randomly assigned to receive either frovatriptan (5.0 mg) or placebo (ratio 1:1).

Subjects.— Took a single dose of study medication at the start of their 20-hour fast. Information about headache intensity, associated symptoms, and use of rescue medication was captured at defined time points from the start of the fast through 20 hours post-fast.

Results.— Of the 75 subjects screened, 74 subjects were randomized and 71 subjects completed the study. Demographic characteristics of the placebo and frovatriptan treatment groups were not statistically different. Thirty-three subjects received active drug. Twelve (36.4%) developed a headache between 6 and 20 hours after the start of the fast (1/33 mild, 11/33 moderate or severe). In the placebo group, 18/34 (52.9%) developed a headache (4/34 mild, 14/34 moderate or severe). The difference between the 2 treatment groups did not achieve statistical significance; Pearson chi-square, = .172.

Kaplan-Meier survival analysis showed no difference between the 2 treatment groups with respect to the time of onset of headache of any intensity (log rank, P = .264) and for the time of onset of a moderate or severe intensity (log rank, P = .634).

Conclusion.— More subjects on placebo developed a headache than those on frovatriptan. Perhaps because of the small number of subjects involved, the differences in headache incidences observed did not achieve statistical significance.

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