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Sumatriptan for the treatment of undifferentiated primary headaches in the ED.
Am J Emerg Med. 2007 Jan; 25(1):60-4.AJ

Abstract

OBJECTIVE

In this study, we determine the effectiveness and adverse effects of sumatriptan when used in the emergency department (ED) as a first-line treatment for benign undifferentiated headaches, and determine if the International Headache Society (IHS) classification of migraine, probable migraine, or tension-type headache has any effect on the effectiveness of the treatment. We hypothesize that there is no difference in the effectiveness of pain relief or frequency and severity of adverse effects between patients with migraine, probable migraine, or tension-type headaches when treated with sumatriptan.

METHODS

This was a prospective observational study of adult ED patients undergoing treatment for primary headaches (ie, patients in whom head trauma, vascular disorders, infection, or disorders of facial or cranial structures have been clinically excluded). Other exclusions were renal impairment, hepatic impairment, and risk factors for coronary artery disease. Consenting patients then were asked to complete a 100-mm visual analog scale (VAS) representing their perceived pain, after which they were interviewed by a research assistant who completed a headache diagnosis worksheet, which differentiates the headache by IHS criteria. The patient repeated the VAS score at 30 and 60 minutes. Data were analyzed using descriptive statistics and chi squared tests.

RESULTS

One hundred forty-seven patients were enrolled: 84 (57.1%) patients with migraine headache, 45 (30.7%) with a probable migraine headache, and 18 (12.2%) with a tension headache. A 50% reduction in VAS scores 60 minutes postdose was seen in 87 (59%) of 147 patients; 50 (60%) of 84 of migraine patients, 25 (56%) of 45 of probable migraine patients, and 12 (67%) of 18 tension patients (P = .72). There were no serious adverse events reported. Forty-seven patients (32%) received rescue medications after the 60-minute VAS score: 29 (34.5%) patients in the migraine group, 15 (33.3%) patients in the probable migraine group, and 3 (15.8%) patients in the tension-type headache group (P = .26).

CONCLUSIONS

Most of the patients presenting with primary headaches had migraine or probable migraine headaches. There was no difference in sumatriptan's effectiveness based on the classification of the headache using IHS criteria.

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Authors+Show Affiliations

Miner JR
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN 55415, USA. miner015@umn.edu
Smith SW
No affiliation info available
Moore J
No affiliation info available
Biros M
No affiliation info available

MeSH

AdultEmergency Service, HospitalFemaleHeadacheHumansMaleMigraine DisordersMinnesotaPain MeasurementProspective StudiesSerotonin Receptor AgonistsSumatriptan

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17157685

Clinical Trial Links

The CHECK Trial: A Comparison of Headache Treatment in the ED: Compazine Versus Ketamine

Citation

Miner, James R., et al. "Sumatriptan for the Treatment of Undifferentiated Primary Headaches in the ED." The American Journal of Emergency Medicine, vol. 25, no. 1, 2007, pp. 60-4.
Miner JR, Smith SW, Moore J, et al. Sumatriptan for the treatment of undifferentiated primary headaches in the ED. Am J Emerg Med. 2007;25(1):60-4.
Miner, J. R., Smith, S. W., Moore, J., & Biros, M. (2007). Sumatriptan for the treatment of undifferentiated primary headaches in the ED. The American Journal of Emergency Medicine, 25(1), 60-4.
Miner JR, et al. Sumatriptan for the Treatment of Undifferentiated Primary Headaches in the ED. Am J Emerg Med. 2007;25(1):60-4. PubMed PMID: 17157685.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sumatriptan for the treatment of undifferentiated primary headaches in the ED. AU - Miner,James R, AU - Smith,Stephen W, AU - Moore,Johanna, AU - Biros,Michelle, PY - 2006/01/19/received PY - 2006/06/12/revised PY - 2006/06/26/accepted PY - 2006/12/13/pubmed PY - 2007/2/9/medline PY - 2006/12/13/entrez SP - 60 EP - 4 JF - The American journal of emergency medicine JO - Am J Emerg Med VL - 25 IS - 1 N2 - OBJECTIVE: In this study, we determine the effectiveness and adverse effects of sumatriptan when used in the emergency department (ED) as a first-line treatment for benign undifferentiated headaches, and determine if the International Headache Society (IHS) classification of migraine, probable migraine, or tension-type headache has any effect on the effectiveness of the treatment. We hypothesize that there is no difference in the effectiveness of pain relief or frequency and severity of adverse effects between patients with migraine, probable migraine, or tension-type headaches when treated with sumatriptan. METHODS: This was a prospective observational study of adult ED patients undergoing treatment for primary headaches (ie, patients in whom head trauma, vascular disorders, infection, or disorders of facial or cranial structures have been clinically excluded). Other exclusions were renal impairment, hepatic impairment, and risk factors for coronary artery disease. Consenting patients then were asked to complete a 100-mm visual analog scale (VAS) representing their perceived pain, after which they were interviewed by a research assistant who completed a headache diagnosis worksheet, which differentiates the headache by IHS criteria. The patient repeated the VAS score at 30 and 60 minutes. Data were analyzed using descriptive statistics and chi squared tests. RESULTS: One hundred forty-seven patients were enrolled: 84 (57.1%) patients with migraine headache, 45 (30.7%) with a probable migraine headache, and 18 (12.2%) with a tension headache. A 50% reduction in VAS scores 60 minutes postdose was seen in 87 (59%) of 147 patients; 50 (60%) of 84 of migraine patients, 25 (56%) of 45 of probable migraine patients, and 12 (67%) of 18 tension patients (P = .72). There were no serious adverse events reported. Forty-seven patients (32%) received rescue medications after the 60-minute VAS score: 29 (34.5%) patients in the migraine group, 15 (33.3%) patients in the probable migraine group, and 3 (15.8%) patients in the tension-type headache group (P = .26). CONCLUSIONS: Most of the patients presenting with primary headaches had migraine or probable migraine headaches. There was no difference in sumatriptan's effectiveness based on the classification of the headache using IHS criteria. SN - 0735-6757 UR - https://www.unboundmedicine.com/medline/citation/17157685/Sumatriptan_for_the_treatment_of_undifferentiated_primary_headaches_in_the_ED_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-6757(06)00262-2 DB - PRIME DP - Unbound Medicine ER -