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Results of a study published in the medical journal Headache on April 30th, 2010 strongly indicate that using the second generation triptan drug Eletriptan, also called Eletripan, may be effective as a prevention for most women who tend to suffer debilitating migraine during menstruation.



Menstrual Migraine (MM) treatment

When menstrual migraine has already started, it can be effectively treated acutely with a variety of agents. Evidence-based guidelines based on evaluation of prospective, double-blind studies provided recommendations for acute treatment with Sumatriptan, Mefenamic acid, and Rizatriptan. The combination of Sumatriptan and Naproxen has also been shown to reduce both menstrual migraine and painful periods (dysmenorrhea) in controlled, randomised trials.



Why Eletriptan for MM? The science bit...

This study was designed to test the hypothesis that perimenstrual treatment with eletriptan would reduce menstrual migraine (MM) diagnosed through 3 months of prospective diaries. Eletriptan was selected because of its generally superior efficacy in comparison with Frovatriptan and Naratriptan in a meta-analysis evaluating efficacy for acute migraine treatment. Furthermore, this same meta-analysis concluded that, compared with Sumatriptan 100 mg acute treatment efficacy for initial pain relief and sustained pain-free response, Zolmitriptan was equivalent and Eletriptan was equivalent to or superior. The hypothesis tested for the treatment phase of this study was that open-label, peri-menstrual treatment with 20 mg Eletriptan administered 3 times daily for a total of 6 days in women with a history of menstrual migraine in every cycle would reduce headache activity by 50%  or more across 3 consecutively treated menstrual cycles.



Efficacy of Eletriptan in Menstrual Migraine

In this study, the number of headache days decreased significantly from pre- to post-treatment during menstrual assessment. The number of headaches during non-menstrual days did not significantly change as a result of treatment. It is of note that they were off treatment then. The mean percentage of treated menses without migraine occurring during the 6 days of treatment was 71.3%. For over half of the participants (53%), there were no migraine headaches at all during menstruation in all the three cycles when they were taking the medication for this study. Also of note is the fact that among these women who remained headache free, for 1 in 12 of them (8.8%),  migraine occurred during the 3 days immediately after discontinuing Eletriptan.




Satisfaction with Eletriptan

The majority of participants in this study showed willingness, even enthusiasm to continue using this drug for preventing menstrual migraine. Overall satisfaction with Eletriptan treatment was: 60.0% very satisfied, 28.9% somewhat satisfied, 8.9% neither satisfied nor dissatisfied, and 2.2% very dissatisfied. Willingness to continue using eletriptan to treat MM was: 53.3% very likely, 31.3% somewhat likely, 11.1% somewhat unlikely, and 4.4% very unlikely.



Study limitations

This study is limited by selection of women who identified themselves as having a significant menstrual aggravation of their migraines. These data therefore cannot be extrapolated to general clinic populations.

On the other hand, consideration for the diagnosis of MM is general restricted to women who self-report retrospectively identified menstrual aggravation. Furthermore, the relatively small sample size and open-label nature of eletriptan treatment limit interpretation of the second phase of this study. Although the predetermined treatment sample was not achieved in this study, significance was identified using the available sample population, supporting good benefit with perimenstrual eletriptan prevention therapy. Menstrual regulation by hormonal therapy might Eletriptan for menstrual migrainehave affected treatment response; however, this study was not powered to identify the possible influence of contraceptive type, especially hormonal contraception, on treatment outcome. Future studies should include larger sample sizes and placebo or other comparator treatment populations. In addition, excellent compliance with 3 times daily dosing in the current study precluded comparing outcome for women using eletriptan less than 3 times daily. Future studies may wish to compare outcome with twice daily versus 3 times daily dosing.




Conclusion

This study does give strong indications that Eletriptan at 20mg three times daily is likely to help prevent attacks for at least half the women who suffer from sometimes debilitating and recurrent menstrual migraine headaches. The dread that comes as the time of the menstrual period approaches may be allayed by this effective and safe drug which is also well tolerated (emphasis ours). Further studies are sure to follow but this is a very encouraging piece of news for sufferers.

Menstrual migraine: Eletriptan may be effective

Compliance on a 20mg three times a day dosage was excellent and reported unwanted effects were minimal.