Women respond differently to treatment of migraine with triptans than men20 November 2020• NEWSITEM
Triptans are the most widely prescribed acute acting treatments in migraine. Women respond differently to this acute treatment than men. Headache researchers from the Leiden University Medical Center (LUMC) and the Erasmus Medical Center (Erasmus MC) concluded that women more often experience headache recurrences and report more side effects.
In their study, the researchers investigated sex differences in the effectivity of triptans. The results have been published in the latest issue of Neurology, the medical journal of the American Academy of Neurology. Migraine affects three times more women than men. Still, little attention is paid to sex specific differences such as efficacy of treatments. This new study concerns a meta-analysis in which results of previous published studies have been combined to answer the question whether there are differences in the efficacy of triptans between men and women.
Role of sex hormonal fluctuations
Daphne van Casteren, researcher, has performed the study under the supervision of neurologist Gisela Terwindt from the LUMC and pharmacologist Antoinette Maassen van den Brink from the Erasmus MC. The team showed that women more often experienced headache recurrence after an initially adequate triptan response. Presumably, this could be explained by the occurrence of migraine attacks that are provoked by sex hormonal changes, such as menstrual related attacks or attacks during menopausal transition.
Compromising with medication
Since these migraine attacks often last for days when untreated, triptans’ duration of action is simply too short to treat the entire attack. This is not due to an insufficient dose of the medication. Actually, women reported more side effects of triptans than men since they are exposed to a larger concentration of the drug after the intake of a similar dose. “Therefore, compromising is needed when prescribing this medication to women” according to van Casteren. Maassen van den Brink: “Physicians should not only ask about the acute effect, but also about the recurrence of attacks and adjust the medication accordingly, taking into account possible side effects.”
“General practitioners often choose to prescribe a low dose of one of the triptans, which increases the risk for recurrence of attacks even further. Better and easily applicable recommendations could be given” according to headache specialist Terwindt. She was recently appointed as professor of Neurology at the LUMC, where she will focus on paroxysmal brain disorders including migraine with specific attention to differences between men and women in neurological disorders. The LUMC is the only academic expertise center for headaches in the Netherlands. "The Leiden Headache Clinic is actually a last resort for many patients with headaches that are difficult to treat," says Terwindt. She therefore hopes with this appointment to put headaches on the map as an area of attention.
More information about women and migraine can be found at www.whatstudy.nl.
Photo: the WHAT! Study team