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  • Title: Revisiting the efficacy of sumatriptan therapy during the aura phase of migraine.
    Author: Aurora SK, Barrodale PM, McDonald SA, Jakubowski M, Burstein R.
    Journal: Headache; 2009 Jul; 49(7):1001-4. PubMed ID: 19438735.
    Abstract:
    OBJECTIVE: To reexamine the efficacy of terminating migraine headache by administration of sumatriptan during the visual-aura phase of the attack. Background.- Although the antimigraine action of triptans is most effective soon after onset of the headache, treatment during the aura phase has been found to be ineffective. METHODS: Nineteen subjects having migraine with aura were studied using a 4-way crossover, open-label design. Each patient was asked to treat 8 consecutive attacks with 100 mg of sumatriptan RT: 3 attacks treated at a timing of the patient's discretion (baseline); 1 attack treated 4 hours after onset of pain (late); 2 attacks treated within 1 hour of onset of pain (early); 2 attacks treated during the aura phase - before the onset of pain (aura). Pain level and cutaneous allodynia were reported by the patients at the onset of pain, at the time of treatment, and 2 and 24 hours after treatment. RESULTS: Sumatriptan treatment during the aura preempted the development of headache in 34/38 (89%) attacks. The same patients were rendered pain-free in 30/38 (79%) of attacks treated within 1 hour of pain onset, and in 4/19 (21%) of attacks treated 4 hours after the onset of pain. The incidence of allodynia at the time of treatment was 2/38 (5%) in attacks treated during aura, 8/38 (21%) in attacks treated early, and 14/19 (74%) in attacks treated late. CONCLUSION: Considering the discrepancy between the present and previous clinical studies, it is worthwhile revisiting the efficacy of preemptive triptan therapy during the aura phase of migraine attacks, using larger-scale, 3-way, crossover, placebo-controlled studies.
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