Migraine medications not linked to stroke risk

Triptans and DHE do not increase the risk of stroke and cardiovascular events.
Triptans and DHE do not increase the risk of stroke and cardiovascular events.

Triptans and dihydroergotamine (DHE) do not increase the risk of stroke and cardiovascular events in patients with basilar or hemiplegic migraines, according to a study published in Headache.

These drugs may also benefit patients with migraine who experience auras.

 “There are not enough medicines out there to appropriately manage migraine headaches,” said researcher Brad Klein, MD, Medical Director of the Headache Center at Abington Hospital-Jefferson Health. “At a time in history when an unprecedented number of people are getting hooked on narcotic opiates by way of prescribed medications – as is the case with migraine sufferers as well – we owe it to ourselves as physicians to try medications that could work without the risk of addiction.”

The retrospective analysis included 67 patients with basilar migraines and 13 patients with hemiplegic migraines. In the basilar group, 40 patients received triptans and 27 received DHE. In the hemiplegic group, 5 patients received triptans and 8 received DHE.

No side effects of stroke or myocardial infarction were reported. Among those taking triptans, 5 participants reported adverse events including gastrointestinal events, rash, neck dystonia, nightmares, and flushing. Among those taking DHE, 5 patients reported adverse events including chest tightness, dystonic reaction, transient asymptomatic anterior T wave inversion, and agitation.

Triptans and DHE are the most commonly used medications for migraine, but the FDA issued a black box warning for basilar and hemiplegic migraines due to risk of stroke.

Patients with basilar or hemiplegic migraines were excluded from the initial studies for triptans and DHE. Both types of drugs are thought to relieve migraines in part by constricting blood vessels; basilar and hemiplegic migraines are thought to cause pain by constricting blood vessels. Drug developers worried that the drugs' added constriction could increase stroke risk.

“As a result,” commented Dr. Klein, “no one ever actually showed that these drugs were dangerous – they were just assumed to be dangerous based on their mechanism of action. And recent research suggests that the auras are not due to blood vessel constriction.”

Reference

  1. Mathew PG, Krel R, Buddhev B, et al. A retrospective analysis of triptan and dhe use for basilar and hemiplegic migraine. Headache. doi:10.1111/head.12804.
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