Managed Healthcare Executive - March 2009 - (Page 19) { DRUG CLASS OVERVIEW } Triptans lead treatment options for migraine management Short-acting oral triptans are similar in efcacy and speed of onset; some patients may respond to one triptan and not to another. Use early in an attack, when pain is mild to moderate, has been shown to improve outcomes. BY ELAINE ZABLOCKI “The nasal spray forms of sumatriptan and zolmitriptan have a faster onset of action than all the oral triptans, and probably deserve wider igraine headaches are common—oc- use,” Dr. Abramowicz says. “Subcutaneous sucurring in about 11 out of 100 people. matriptan is expensive, but it is the fastest acting They tend to start between the ages and most e ective triptan formulation.” of 10 and 46, and occur more often in women Overuse (two or more days per week, for than men. more than three months) of OTC medicaMigraine headaches can be incapacitating, tions, ergot medications or triptans can lead to including pain and symptoms such as nausea, medication-overuse headache. To prevent this, vomiting, or sensitivity to light. Many people restrict the use of these drugs per attack, per experience a throbbing pain on only one side week, and per month, Dr. Abramowicz says. of the head. Some migraine patients experiTo prevent migraine attacks, the antiepilepence warning symptoms, called an aura, before tics Depakote (valproate) and Topamax (topithe actual headache begins. Some migraine ramate) are increasingly used, but there is no attacks are triggered by stress, lack of food or evidence that they are more e ective than betasleep, exposure to bright lights, certain odors, blockers, which cost much less. The side e ects or (in women) hormonal changes. of beta-blockers can include fatigue, depresScientists used to believe migraines were sion, and orthostatic hypotension. Side e ects linked to the opening and narrowing of blood of anti-epileptics include nausea, fatigue and vessels in the head. Now they believe the cause weight gain. is related to genes that control the activity of certain brain cells. EDUCATIONAL GROUP SESSIONS Several di erent classes of medications Physicians in the Kaiser Permanente Southern can help prevent migraine attacks or relieve California region have found that group-based symptoms of attacks when they occur. An interventions for migraine patients lead to over-the-counter pain reliever such as aspi- better outcomes, as well as lower overall rin, acetaminophen or ibuprofen may be ef- costs for the MCO. In a study reported in fective in treating mild to moderate migraine. 2003, small groups of migraine patients (264 They are also marketed in combinations with total) attended an educational session led by a ca eine and other medicines. nurse practitioner, with follow-up consulta“A triptan is the drug of choice for treatment tions. Participants experienced a 49% reducof moderate to severe migraine headache,” says tion in headache-related ER visits and a 32% Mark Abramowicz, MD, editor in chief of reduction in clinic visits. There was a 19% The Medical Letter on Drugs and Therapeutics, a increase in pharmacy costs for the group as non-pro t newsletter that critically appraises a whole ($5,423) but overall healthcare costs Elaine Zablocki has drugs. “Oral ergot preparations cost less than were reduced by $18,757 despite increased been reporting on the triptans, but are not as e ective and are triptan costs. healthcare for more than a dozen years. associated with more adverse events.” Although these sessions were led by a nurse OTC analgesics also are effective to treat migraines, while group educational sessions empower patients to cope with recurrence M MARCH 2009 19
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