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| |  DG DISPATCH - HEADACHE: Rizatriptan Effective In Treating Menstrual Migraines By Cameron Johnston Special to DG News BARCELONA, SPAIN -- June 25, 1999 -- The novel 5Ht1b/1d receptor agonist Maxalt (rizatriptan, Merck & Co) is effective specifically in treating migraine headaches that occur around the time of a woman’s menstrual period, according to new research presented at the 9th International Headache Society meeting in Barcelona, Spain. Researchers reported that 10 mg of Maxalt was more effective than the 5 mg dose and more effective than placebo at relieving the pain of menstrual migraine as well as photo and phono-phobia, without inducing nausea. It is believed that up to 60 percent of women with migraines relate their headaches to their menstrual cycle, but only 7-14 percent experience migraines around the time of menstruation - which is termed a "pure menstrual migraine". It is generally felt that it is the fluctuations in estrogen throughout the month and around the time of menses that triggers these attacks. The rizatriptan study involved 139 women who took the 10 mg dose, 115 women who took the 5 mg dose and 81 who took a placebo. For the purposes of this study, menstrual migraine was defined as a migraine that occurred within three days prior to the woman’s period, or within three days of her period beginning. While the smaller dose of 5 mg was more effective at reducing pain (ie. it was not eliminated entirely) more patients said they were completely pain-free when they took the 10 mg dose. Both doses of rizatriptan were more effective when compared with placebo. Significantly more women were able to manage their headache without rescue medication: 79 percent in the 10 mg group and 73 percent in the 5 mg group, compared with 59 percent in the placebo group. More than twice as many women in the two rizatriptan groups reported being able to resume normal functional activities within two hours of the initial dose. Dr. Richard Lipton, a professor of neurology and epidemiology at Albert Einstein College of Medicine in New York City said that menstrual migraine should not be thought of as a distinct kind of headache, but rather as a migraine with a distinct trigger. “That’s the most useful way of dealing with it,” he said. “The perception that menstrual migraines are more disabling or more painful than migraines that occur at other times of the month is not true, but those headaches are of longer duration and therefore more difficult to treat,” he said. “Perhaps the reason for that is that there is a persistent hormonal trigger related to estrogen withdrawal.” “Virtually all triptans, if you do a sub-group analysis, will work with menstrual migraines,” he added. Dr. Peter Goadsby, of the Institute of Neurology, National Hospital for Neurology and Neurosurgery in London, England, said it is encouraging that a particular medication works in treating menstrual migraines, but he cautioned that rizatriptan - or any other triptan for that matter - might not be appropriate for all menstrual migraines. “For me, you use what’s appropriate for the attack that you have, and some will be treated with a triptan, and some not. But I don’t think you have to mandate the use of triptans in all menstrual headaches. I don’t think that would be fair. If non-steroidals work I would use non-steroidals,” he said in an interview.
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