Headache Currents—Clinical Review
QT Prolongation, Torsade de Pointes, Myocardial Ischemia From Coronary Vasospasm, and Headache Medications. Part 2: Review of Headache Medications, Drug–Drug Interactions, QTc Prolongation, and Other Arrhythmias
Article first published online: 6 DEC 2012
© 2012 American Headache Society
Headache: The Journal of Head and Face Pain
Volume 53, Issue 1, pages 217–224, January 2013
How to Cite
Stillman, M. J., Tepper, D. E., Tepper, S. J. and Cho, L. (2013), QT Prolongation, Torsade de Pointes, Myocardial Ischemia From Coronary Vasospasm, and Headache Medications. Part 2: Review of Headache Medications, Drug–Drug Interactions, QTc Prolongation, and Other Arrhythmias. Headache: The Journal of Head and Face Pain, 53: 217–224. doi: 10.1111/j.1526-4610.2012.02299.x
- Issue published online: 8 JAN 2013
- Article first published online: 6 DEC 2012
- Manuscript Accepted: 1 OCT 2012
- polymorphic ventricular tachycardia;
- Torsade de Pointes;
- corrected QT prolongation;
- Prinzmetal angina;
- migraine medication
Serotonin (5-hydroxytryptamine)1B/1D agonists can vasoconstrict coronary and cerebral arteries. Chest, jaw, and arm discomfort, so-called “triptan sensations,” are often felt to be noncardiac. In Part 1 of this review, the relationship of triptans, coronary artery narrowing, and spasm was discussed, along with a case of a 53-year-old woman without cardiac risk factors who developed polymorphic ventricular tachycardia and cardiac ischemia with acquired corrected QT (QTc) interval prolongation following oral sumatriptan.
In Part 2 of this review, headache medications, drug–drug interactions, QTc prolongation, and cardiac arrhythmias are appraised and discussed. Triptans, cardiac arrhythmias, and ischemia by prescribing information are summarized. The reader is provided tables on QTc prolongation by medication.
The problem of QTc prolongation with a variety of headache medications at conventional doses, including triptans, serotonin reuptake inhibitors (selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors), other antidepressants, antihistamines, and antinauseants should lead to proactively obtaining electrocardiograms and more vigilant surveillance of headache patients. This may be the place to start in protecting patients from these cardiac adverse events.