Level B Pharmacologic Agents
Venlafaxine and Amitriptyline. The efficacy and AEs of venlafaxine and amitriptyline in the prophylactic treatment of migraine were compared in a randomized, double-blind, crossover study. Patients, who underwent a 4-week run-in period with no prophylactic treatment, kept a headache diary noting the number, duration (hours), and severity of migraine attacks. Fifty-two of 76 patients completed the study. Five patients dropped out because of intolerable AEs associated with amitriptyline, and one dropped out because of AEs from venlafaxine. Both drugs were effective for migraine prophylaxis, but the difference between them was NS. Venlafaxine and amitriptyline were beneficial for pain parameters (P <.01) and achieved reductions in migraine frequency, intensity, and duration (P <.01). Although both drugs are effective, the AE profile of XR venlafaxine is much more favorable and tolerable than that of amitriptyline.
Naratriptan. The efficacy of naratriptan for short-term prevention of MAM during perimenstrual periods was examined in a randomized, double-blind, placebocontrolled study. Subjects took naratriptan 1 mg twice daily, 2.5 mg twice daily, or placebo twice daily. The primary efficacy endpoint was the number of MAMs occurring over four perimenstrual periods. It was concluded that naratriptan 1 mg twice daily is efficacious for preventive treatment of MAM and exhibits a welltolerated AE profile. Although naratriptan 2.5 mg showed some traces of efficacy, the difference versus placebo was NS.
Zolmitriptan. A randomized, placebo-controlled study examined the efficacy and safety of zolmitriptan in the short-term prevention of MAM. A total of 244 subjects were assigned to three treatment groups: zolmitriptan 2.5 mg orally twice daily (n = 80), zolmitriptan 2.5 mg orally three times daily (n = 83), and placebo three times daily (n = 81). Subjects, who were treated for three menstrual cycles, began therapy 2 days prior to onset of menses and continued after onset for a total of 7 days of treatment. The primary efficacy endpoint was a 50% or greater reduction in frequency of MAM attacks. Both zolmitriptan groups had efficacy superior to that of placebo in the prophylactic treatment of MAM.