Frovatriptan may be the triptan of choice for the acute treatment of menstrual migraine attacks, according to reanalyses of data from double-blind, randomized crossover trials involving the drug.

Frovatriptan’s lengthy half-life – the longest of all the triptans – and prolonged duration of clinical effect make it a particularly attractive option for the treatment of menstrual migraine attacks, which are typically longer in duration and more susceptible to relapse than migraine not related to menstruation, said Dr. Lidia Savi, a neurologist at the University of Turin (Italy).

Dr. Lidia Savi
At the European Headache and Migraine Trust International Congress, she presented a secondary analysis of data from a published, double-blind, randomized, multicenter crossover trial of frovatriptan (Frova) versus almotriptan (Axert) for the acute treatment of migraine (J. Headache Pain 2011;12:361-8). Both men and women were included in the parent study. The newer secondary analysis was restricted to the 67 participants with regular menstrual cycles.

In 155 menstrual migraine attacks treated in double-blind fashion, the two triptans displayed similar short-term efficacy, as reflected in pain relief and pain-free episodes 2 and 4 hours post treatment. However, the recurrence rate within 48 hours after treatment was just 9% in frovatriptan-treated episodes, significantly less than the 24% rate for almotriptan (J. Headache Pain 2012;13:401-6).

In a separate presentation, Dr. Anne MacGregor emphasized that menstrually related migraine is a distinct clinical entity. Affected women find it considerably more problematic than migraine occurring at other times of the menstrual cycle.

She cited a study by other investigators who prospectively studied headache episodes in 107 women with frequent and disabling migraine attacks, both menstrually related and otherwise. The menstrually related attacks were significantly less likely to be pain free at 2 hours post treatment, were more likely to last longer than 72 hours, were more severe, had more associated symptoms, were more susceptible to relapse, and inflicted greater disability (Cephalalgia 2010;30:1187-94).

When not managed effectively, menstrual migraine attacks often cause women to develop a greater fear of migraine, with resultant added psychological and functional disability between episodes, said Dr. MacGregor of the Barts Sexual Health Centre at St. Bartholomew’s Hospital and the London School of Medicine and Dentistry.

Dr. Anne MacGregor
“Frovatriptan is something that can give these patients that little extra bit of control. This is something quite positive that we can take home as a message to our patients: Frovatriptan is an option worth trying for menstrual attacks of migraine,” she added.

Dr. Gianni Allais presented a pooled analysis of Dr. Savi’s study plus two other published Italian randomized, double-blind crossover clinical trials of frovatriptan versus rizatriptan (Maxalt) (J. Headache Pain 2011;12:609-15) and zolmitriptan (Zomig) (Neurol. Sci. 2011;32[suppl. 1]:S99-104). The pooled subgroup analysis covered the 187 women with at least one episode of menstrual migraine treated with frovatriptan and one episode treated with one of the other triptans.

Rates of being pain free and having pain relief 2 and 4 hours post treatment were similar across the board. However, recurrence rates were significantly lower for frovatriptan-treated episodes than for those treated with any of the other agents. At 24 hours of follow-up, the recurrence rate was 11% following frovatriptan versus 24% collectively for the comparator triptans. The 48-hour recurrence rate was 15% with frovatriptan, compared with 26% for the other triptans in this recently published pooled analysis (Neurol. Sci. 2012;33[suppl. 1]:S65-9), reported Dr. Allais of the women’s headache center at the University of Turin.

The frovastatin studies were funded by the Menarini Group, which markets the triptan in Italy. Dr. Savi, Dr. MacGregor, and Dr. Allais serve as consultants to the company.