Triptans may be safe for migraine with prominent neurologic symptoms

NEW YORK (Reuters Health) – Contrary to widely held beliefs, triptans may be a safe and effective treatment for migraine with prominent neurologic symptoms, such as basilar migraine and migraine with prolonged aura, according to results of recent report.

Triptans have been contraindicated for the treatment of such migraines, based on the fear that they would aggravate the vasoconstrictive process that seems to cause the neurologic symptoms, investigators explain.

Dr. Jack A. Klapper, from the Colorado Neurology and Headache Center in Denver, and colleagues assessed the outcome of 13 patients who had migraine with prominent neurologic manifestations. All but one of the patients was female and ranged in age from 15 to 48 years.

All of the patients responded well to triptan therapy, reporting either complete or major relief of all symptoms. Furthermore, no adverse effects were reported by any of the patients, the researchers note in the November/December 2001 issue of Headache: The Journal of Head and Face Pain.

The researchers postulate that the prolonged auras that occur may not result from a vasoconstrictive process but rather from spreading depression. By modulating nitric oxide neurotransmission, the triptans may inhibit this neurologic phenomenon and improve aura symptoms. Another possibility is that triptans reverse the increased basilar artery vascular tone often found in these patients.

"The existing proscription against the use of the triptans in [migraine with prominent neurologic symptoms] lacks scientific basis and may, in fact, be depriving our patients of a particularly safe and effective treatment intervention," the authors state. "Our clinical experience reported here suggests that this proscription should be reconsidered."

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