Midrin or Imitrex for Aborting Migraine?
Updated September 10, 2014.
Stratification of abortive care for Migraine is somewhat like triage in an emergency room or accident scene. The Migraine attack is evaluated, and the medications taken are based on that evaluation. The more severe the attack is, the more high powered the medication used should be.
Stratification of care came into play in the recently published results of a Comparative Study of a Combination of Isometheptene Mucate, Dichloralphenazone With Acetaminophen (Midrin®) and Sumatriptan Succinate (Imitrex®) in the Treatment of Migraine.*
Study Objective:
- "To compare the safety and efficacy of isometheptene mucate, dichloralphenazone with acetaminophen to sumatriptan succinate for the treatment of mild-to-moderate Migraine, with or without aura, when taken at the first sign of an attack."
Both Midrin® and Imitrex® are approved by the FDA for Migraine treatment. In stratified Migraine care, patients whose attacks are mild to moderate may do quite well with medications other than triptans. One reason is that it is often more efficient to reserve triptans for more severe attacks. Another is the significantly higher cost of treatment with triptans. Another element to the study is that early treatment of a Migraine attack may improve the level of response to medications.
Study Methods:
- "This was a multicenter, double-blind, randomized, parallel-group study to assess the safety and efficacy of the combination of isometheptene mucate, dichloralphenazone with acetaminophen and sumatriptan succinate in the early stages of a single Migraine attack. Patients diagnosed with Migraine, with or without aura, as defined by the International Headache Society diagnostic criteria were enrolled."
Package insert recommendations for dosage were followed, and the patients were told to begin medication at the first symptom recognized as the beginning of a Migraine attack. Additional doses could be taken each hour for the next three hours, but they were not to take other medications for at least two hours after the initial dose of the trial medications.
As well as recording the times at which they took medications, participants recorded pain intensity and functional disability on a scale of one to four as well as noting all Migraine-associated symptoms. In cases where the headache phase had stopped, but recurred, patients logged the characteristics of the recurrent headache.
Conclusions:
- Imitrex® and Midrin® both are effective and safe for use early in the Migraine attack.
- Some data of the study suggests that Midrin® may have some advantages over Imitrex® when using a stratified care approach to Migraine attacks.
- Midrin® should be listed as a primary medication for early treatment of mild to moderate Migraine attacks. (Imitrex® is already listed as a primary medication for these attacks.)
________________
* Reference:
Freitag, Frederick G., Cady, Roger, DiSerio, Frank, Elkind, Arthur, Gallagher, R. Michael, Goldstein, Jerome, Klapper, Jack A., Rapoport, Alan M., Sadowsky, Carl, Saper, Joel R. & Smith, Timothy R. "Comparative Study of a Combination of Isometheptene Mucate, Dichloralphenazone With Acetaminophen and Sumatriptan Succinate in the Treatment of Migraine." Headache: The Journal of Head and Face Pain 41 (4), 391-398.
A recent study compared Midrin and Imitrex taken at first sign of attack
Stratification of abortive care for Migraine is somewhat like triage in an emergency room or accident scene. The Migraine attack is evaluated, and the medications taken are based on that evaluation. The more severe the attack is, the more high powered the medication used should be.
Stratification of care came into play in the recently published results of a Comparative Study of a Combination of Isometheptene Mucate, Dichloralphenazone With Acetaminophen (Midrin®) and Sumatriptan Succinate (Imitrex®) in the Treatment of Migraine.*
Study Objective:
- "To compare the safety and efficacy of isometheptene mucate, dichloralphenazone with acetaminophen to sumatriptan succinate for the treatment of mild-to-moderate Migraine, with or without aura, when taken at the first sign of an attack."
Both Midrin® and Imitrex® are approved by the FDA for Migraine treatment. In stratified Migraine care, patients whose attacks are mild to moderate may do quite well with medications other than triptans. One reason is that it is often more efficient to reserve triptans for more severe attacks. Another is the significantly higher cost of treatment with triptans. Another element to the study is that early treatment of a Migraine attack may improve the level of response to medications.
Study Methods:
- "This was a multicenter, double-blind, randomized, parallel-group study to assess the safety and efficacy of the combination of isometheptene mucate, dichloralphenazone with acetaminophen and sumatriptan succinate in the early stages of a single Migraine attack. Patients diagnosed with Migraine, with or without aura, as defined by the International Headache Society diagnostic criteria were enrolled."
Package insert recommendations for dosage were followed, and the patients were told to begin medication at the first symptom recognized as the beginning of a Migraine attack. Additional doses could be taken each hour for the next three hours, but they were not to take other medications for at least two hours after the initial dose of the trial medications.
As well as recording the times at which they took medications, participants recorded pain intensity and functional disability on a scale of one to four as well as noting all Migraine-associated symptoms. In cases where the headache phase had stopped, but recurred, patients logged the characteristics of the recurrent headache.
Conclusions:
- Imitrex® and Midrin® both are effective and safe for use early in the Migraine attack.
- Some data of the study suggests that Midrin® may have some advantages over Imitrex® when using a stratified care approach to Migraine attacks.
- Midrin® should be listed as a primary medication for early treatment of mild to moderate Migraine attacks. (Imitrex® is already listed as a primary medication for these attacks.)
________________
* Reference:
Freitag, Frederick G., Cady, Roger, DiSerio, Frank, Elkind, Arthur, Gallagher, R. Michael, Goldstein, Jerome, Klapper, Jack A., Rapoport, Alan M., Sadowsky, Carl, Saper, Joel R. & Smith, Timothy R. "Comparative Study of a Combination of Isometheptene Mucate, Dichloralphenazone With Acetaminophen and Sumatriptan Succinate in the Treatment of Migraine." Headache: The Journal of Head and Face Pain 41 (4), 391-398.
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