Quiz Form

Question Date: 27/06/2023

Question: A 50 year old lady has disabling migraine headaches every week. Initially her headaches would respond to paracetamol, but now she gets no relief despite taking two tablets. She had myocardial infarction one year ago and is on aspirin and statin. She is currently on Escitalopram 5 mg per day for anxiety. The prescribing doctor is contemplating triptan for acute treatment.<br><br>Which of these statements would be true regarding triptans for acute treatment?

Options:

• Triptans should be avoided as they increase the risk of stroke or myocardial infarction
• Frequent attacks make her at risk for medication overuse with triptan
• Triptans are not superior to NSAIDS
• Co prescription of antidepressant increases risk of serotonin syndrome

Correct Answer: Triptans should be avoided as they increase the risk of stroke or myocardial infarction

Explaination: Triptans are considered first line medication for acute treatment of moderate to severe migraine attack. They provide 2 hour pain relied in 42-76% and are superior to NSAIDS, but less effective than combination of triptan and NSAID. Triptans need to be given early in the attack and headache recurs in a third and does not respond in a third. Patient should be counselled that use of triptans more than 10 days a month may lead to medication overuse headache, however frequent headache does not preclude its use. They are contraindicated in patients with stroke, myocardial ischemia, bowel ischemia and peripheral vascular disease. Although they may cause serotonin syndrome, the risk in co-prescription with other serotonergic medication is very low.

Reference: Allani J. Acute Migraine treatment. Continuum.2021:27(3, Headache):597-612