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Frovatriptan for acute migraine

Clinical bottom line

Frovatriptan is an effective treatment for acute migraine, though at 2.5 mg it is not as effective early on as some other triptans. It may have longer duration of action because of a considerably longer half life.

Systematic review

This was a large systematic review of triptans that included unpublished material as well as published material. Trials had to be randomised and double blind, treating moderate or severe migraine pain, according to HIS diagnostic criteria, within eight hours of onset.

References

MD Ferrari et al. Oral triptans (serotonin 5-HT aginists) in acute migraine treatment: a meta-analysis of 53 trials. Lancet 2001 358: 1668-1675.
J Goldstein. Frovatriptan: a review. Expert Opinion in Pharmacotherapy 2003 4: 83-93.

Results

Placebo and active controlled trials of frovatriptan have involved about 5,000 patients; it has not been the subject of a sensible systematic review. About 40% of patients with moderate or severe migraine headache have headache relief at two hours, and about 60% by four hours. Pain free rates are about 14% at two hours and 30% by four hours.

Frovatriptan 2.5 mg is somewhat less effective than some other triptans in terms of headache response or pain free outcomes at two hours. Analysis of about 2,000 patients in five randomised trials, while not easy, does show that the NNTs for two hour headache response was about 5, and that for two hour pain free was about 10.

Frovatriptan is differentiated from other triptans by having a considerably longer half life of about 26 hours, while naratriptan has a half life of about 6 hours, and other triptans one of 2-4 hours. There is limited evidence that this makes a clinically useful reduction in headache recurrence.

Comment

Frovatriptan 2.5 mg is effective for treating acute migraine, and will be a useful therapy for some patients.