Low migraine headache recurrence with naratriptan: Clinical parameters related to recurrence

Objective.-To evaluate clinical parameters that may affect the incidence of headache recurrence or the time to headache recurrence, or both, in migrai neurs treated with naratriptan, 2.5-mg tablets. Background.-The incidence of headache recurrence within 24 hours of treatme nt with naratriptan, 2.5-mg tablets (17%-28%), is lower than that reported for other currently available selective serotonin agonists. Identifying cli nical parameters that influence headache recurrence may further reduce the incidence of headache recurrence or prolong the time to recurrence, or both , for naratriptan-treated patients. Methods.-We examined the effects of three clinical parameters (predose pain severity, headache duration prior to treatment, and relief status 4 hours post dose) on the incidence of and time to headache recurrence across four placebo-controlled naratriptan clinical trials. The impact of these paramet ers on headache recurrence was examined individually and in combination. Results.-Predose pain severity had no effect on the incidence of headache r ecurrence (overall 23%; moderate 22%, severe 23%). The median time to recur rence was longer for patients with moderate pain before treatment compared with patients with severe pain before treatment (14.5 hours versus 9.3 hour s, respectively). Overall time to headache recurrence was 11.8 hours. Patie nts with headache recurrence reported a longer time until they treated the headache compared with patients without headache recurrence (median, 145 mi nutes versus 97.5 minutes). Patients who treated headache pain within 3 hou rs of onset had a lower incidence of headache recurrence (20%) than patient s who treated their headache more than 3 hours after onset (28%). Patients with no pain 4 hours post dose had a lower incidence of and a longer time t o headache recurrence compared with patients with mild pain 4 hours post do se (17% versus 32%; median, 17.8 hours versus 8.1 hours, respectively). The interaction of all three clinical parameters was significant in predicting headache recurrence. Conclusions.-The overall incidence of headache recurrence is low after nara triptan, 2.5 mg, compared with other currently available selective serotoni n agonists. Predose pain severity, time to treatment, and 4-hour relief sta tus appear related to the incidence of or time to headache recurrence, or b oth. Treating less severe migraine attacks, treating earlier within an atta ck, and obtaining complete relief post dose may enhance the low incidence o f headache recurrence and achieve longer times to recurrence with naratript an, 2.5 mg.