Reduction in the intensity of abortive migraine drug use during coumarin therapy

Objective.-To investigate the impact of coumarin therapy on migraine attack frequency. Background.-Sporadic case reports and clinical studies have described benef icial effects of coumarin therapy on migraine severity. Design and Methods.-A retrospective follow-up study based on a prescription database covering a population of 450000 was conducted. All patients using an abortive migraine drug (ergotamine or sumatriptan) and subsequently tre ated with either coumarin (index group) or low-dose acetylsalicylic acid (c ontrol group) were analyzed. The impact of coumarin and low-dose acetylsali cylic acid on the frequency of migraine attacks was assessed by measuring t he intensity of ergotamine and sumatriptan use, in defined daily doses per month per patient, before and during coumarin or acetylsalicylic acid treat ment. In addition, a "therapeutic intensity reduction" was determined for e ach patient. Results.-The study population consisted of 92 patients; 35% had been prescr ibed coumarin and 65% had been prescribed low-dose acetylsalicylic acid aft er the initiation of ergotamine or sumatriptan. Two thirds of the study pop ulation was treated with ergotamine. Overall, ergotamine and sumatriptan us e for the coumarin cohort decreased from 6.4 defined daily doses per month prior to coumarin treatment to 3.0 defined daily doses during coumarin trea tment, compared with a reduction from 5.2 defined daily doses per month to 4.4 defined daily doses per month for the low-dose acetylsalicylic acid coh ort (P > .05). The therapeutic intensity of ergotamine and sumatriptan use was significantly decreased by 40% for the coumarin cohort, compared with 4 .7% for the low-dose acetylsalicylic acid cohort (P=.004). Conclusions.-We observed that coumarin treatment was clearly associated wit h a reduction in the therapeutic intensity of abortive migraine drug use in comparison with low-dose aspirin treatment. This suggests that, overall, t he coumarin cohort had experienced a substantial reduction in the frequency of migraine attacks during anticoagulation treatment. Our findings, as wel l as those of others, justify a controlled clinical trial to further establ ish the effects of coumarin therapy on migraine severity and its possible r ole in the prophylactic management of patients suffering from migraine.