Effectiveness of Nasal Sumatriptan in 5- to 12-year-old Children
To assess the effectiveness of nasal sumatriptan in children age 5 to 12.
Headaches in children are common, with migraines in up to 10.6%. Nasal sumatriptan has been reported effective in adolescent migraines. In younger children it is yet to be characterized. We previously reported that nasal sumatriptan is well-tolerated in children.
Design and Methods:
Children were referred by primary care physicians and evaluated by a child neurologist, child psychologist and pediatric nurse practitioners. Clinical and IHS diagnoses were established. Patients unresponsive to oral medications were treated with nasal sumatriptan. Initial administration and tolerability was performed in the office. Patients parents were asked about the overall effectiveness of home administration.
9 patients (5-12 years, mean 9.7 ±2.5) received 5 mg. (2) or 20 mg. (7) of sumatriptan. All 9 had migraines, 6 met IHS criteria. 7 were female and 8 were Caucasian. The pain was frontal in 5 and bitemporal in 5 (2 had both). The pain was throbbing in 6. The mean headache duration was 16.3 ± 11.4 hrs. The mean monthly frequency at presentation was 12.6 ± 10.8. The mean severity was 8.3 ± 1.1 out of 10. A total of 47 headaches have been treated, with 38 (80.9%) responding to medication. Of those who have treated a headache, on average 5.9 ± 5.2 have been treated, with a mean of 4.7 ± 5.7 responsive headaches. 1 patient had no response to 5 trials, 2 patients reponded to 50%, and 5 patients had 100% response. 2 patients reported persistent "bad taste" and 1 patient switched to a different triptan.
Nasal sumatriptan has been shown effective in adult and adolescent migraines. This report demonstrates that nasal sumatriptan may be effective in young children. There may also be sub-groups for which it works better. This information suggests that further investigation (double-blinded, placebo-controlled) is necessary to determine the overall effectiveness of nasal sumatriptan in this age group.
Concurrent Use of Sumatriptan and Naratriptan in Migraineurs with Recurrent Headache
Headache recurrence has traditionally been treated with a second dose of triptan medication once the headache reappears. Naratriptan combined with oral, subcutaneous or intranasal sumatriptan provides an alternative strategy to prevent recurrence and is pharmacologically and pharmacokinetically rational. This combination may be particularly effective for early recurrence, two to six hours following initial relief, since naratriptan would exert its clinical effect about the time recurrence occurs. This observational study determined if patients known to experience recurrent headaches could reduce the frequency and/or severity of recurrence by the concurrent use of sumatriptan and naratriptan.
Patients with at least a 6-month history of successfully using sumatriptan to treat their headaches and who were experiencing early recurrent headache took naratriptan 2.5 mg. with their "usual" dose and form of sumatriptan, at or near the onset of headache. No additional doses were allowed for 12 hours. Patients with cardiovascular risk factors were excluded. Efficacy was assessed by the investigator using patient interviews and a global scale (4=very effective, no recurrence; 3=effective, moderate reduction in headache recurrence severity (HRS); 2=somewhat effective, slight reduction in HRS; 1=not effective). The numbers of headaches, route, dose and reported side effects were tabulated.
Eleven patients treated 109 headaches (distribution/patient: 40, 16, 12, 10, 10, 3, 2, 2, 1, 1). Seven of 11 patients (84 attacks) found the combination very effective with no recurrence. One patient found it effective; two, somewhat effective; and one, ineffective. One patient reported nausea and other typical triptan symptoms.
In this study, concurrent sumatriptan and naratriptan eliminated or reduced recurrence in most patients experiencing early recurrence and was well tolerated.
The Triptans: Imitrex (sumatriptan)
The following was taken from Seminars in Headache Management, Volume 3: Number 4, December 1998.
One study investigated health-related quality of life in relation to long-term use of sumatriptan therapy for migraine. Patients were given sumatriptan in two open-label studies over 42 months and filled out quality of life questionnaires. The most notable improvements in quality of life occurred in the first year, and were sustained clinically and statistically significant across several general and disease-related quality of life scores, including social functioning, vitality, body pain, and emotional function
Another study compared the speed of response to and the efficacy of the three forms of sumatriptan (tablets, nasal spray, and injection). Onset of headache response occurred at 10 minutes in three of four sumatriptan 6 mg. injections studies, at 15 minutes in three of five sumatriptan 20 mg. nasal spray studies, and at 30 minutes in one study of the sumatriptan 50 mg. tablet. Headache response 2 hours after administration was 73-82% for the injection (placebo 28-39%), 55-64% for the nasal spray (placebo 25-35%), and 61% for the 50 mg. tablet (placebo 28%)
Researchers reported two separate studies showing that, compared to placebo, sumatriptan injection reduced mean productivity loss by nearly 50% in more than 75% of patients during a work shift of eight hours
Another group of researchers reviewed an open-label study of sumatriptan injection tolerance conducted over two years. Adverse events were recorded in 50-60% of frequent to moderate users; this rate did not change over time. There was no report of tolerance developing to the medication with long-term
In a study that compared sumatriptan nasal spray and dihydroergotamine (DHE) nasal spray, researchers found that sumatriptan spray worked quicker and in a higher percentage of patients compared to DHE. At 1 hour, 52% of headache patients given sumatriptan had responded, versus 40% given DHE. At 2 hours, 62% of those given sumatriptan had responded, versus 51% given DHE. Recurrence, however, occurred in 23% of patients using sumatriptan and 13% of patients using DHE