Naratriptan in the prophylaxis of transformed migraine

We report three patients with transformed migraine, previously refractory t o a wide variety of traditional preventive pharmacologic and nonpharmacolog ic interventions. Naratriptan 2.5 mg given each morning, with a second tabl et allowed for breakthrough headache, at least 4 hours later, demonstrated a remarkable reduction in frequency and intensity of daily headache, In add ition, a subjective improvement in quality of life and restoration of funct ioning including a decrease in missed workdays was noted, All three patient s had previously experienced good responses to sumatriptan or zolmitriptan, but were limited in frequency of use by the authors. The patients were not experiencing rebound phenomena at the onset of treatment with naratriptan. Clinical responses were noted within 3 to 7 days of initiation of treatmen t. Traditional risk factor analysis and screening were performed. Naratript an was extremely well tolerated, with no cardiovascular adverse events repo rted or observed. Possible mechanisms of action are discussed.