Use of Triptans and DHE in basilar and hemiplegic migraine
Triptans and DHE (dihydroergotamine) are not prescribed for the treatment of basilar (BM) and hemiplegic migraine (HM) because of the increased risk of developing ischemic vascular events. The contraindication of its use in BM and HM as part of labelling instructions has been made compulsory by FDA.
Researchers are continuously trying to evaluate the effectiveness of these drugs in BM & HM, and recently a study was conducted to determine the use of triptans and DHE in the futile treatment of BM and HM without substantial adverse ischemic vascular events.
In this study, a retrospective chart review was conducted at 4 centers for the patients with BM or HM features receiving acute abortive treatment with either triptans or DHE. The aim of the researchers was to measure the occurrence of ischemic vascular events after administration. Headache experts diagnosed BM or HM as per “The International Classification of Headache Disorders, 2nd edition (ICHD-II).
A total of 67 patients with BM features and 13 patients with HM were involved. 40 out of 67 patients in BM group received triptans and 20 received DHE while 5 out of 13 patients in HM group received triptans and 8 received DHE. There were no side effects of stroke or myocardial infarction. Few GI related adverse effects (upset, rash, neck dystonia etc.) were reported by 5 patients in triptan group and 5 patients from DHE group reported some adverse events which involved chest tightness, dystonic reaction, transient asymptomatic anterior T wave inversion, and agitation.
Overall, there was no major adverse event reported with use of triptans and DHE in BM and HM migraine. However, studies with larger sample size may provide more clear evidence regarding the use of triptans and DHE in BM and HM, and its association with increased risk of ischemic vascular events.