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Migraine Drugs Don't Cause Stroke, Heart Disease

British study finds no increased risk with triptan use

MONDAY, Feb. 23, 2004 (HealthDayNews) -- A major British study allays lingering fears that the triptan drugs widely prescribed for migraine headaches might increase the risk of stroke, heart attack and other cardiovascular diseases.

"We find that triptan treatment in migraine does not increase the risk of stroke, myocardial infarction [heart attack], cardiovascular death, ischemic heart disease or mortality," says Gillian C. Hall, a consulting neurologist in private practice and lead author of a report on the study in the February issue of Neurology.

One reason is that the migraine patients in the study with known risk factors for cardiovascular disease were less likely to be given prescriptions for a triptan, Hall notes.

Triptans were introduced about a decade ago, and a half dozen are now on the market. They are prescribed when painkillers such as aspirin and acetaminophen do not relieve the piercing symptoms of a migraine attack.

Triptans act by narrowing the blood vessels in the brain that expand when a migraine occurs, and they can cause chest pain similar to what occurs in a heart attack or angina. So, they are not recommended for use in people with known or high risk of cardiovascular disease.

Fears that triptans might be dangerous for all patients were triggered by some widely publicized incidents soon after they were introduced, explains Dr. Seymour Diamond, director of the Diamond Headache Clinic in Chicago and executive chairman of the National Headache Foundation.

Early on, the drugs were prescribed indiscriminately, Diamond says, but that has changed.

"I have the largest and oldest headache clinic in the United States and have thousands of patients on triptans," Diamond says. "I have never seen any adverse cardiac symptoms from them. If the restrictions on the label are followed, they are wonderful drugs. It is the physicians who prescribe triptans without considering the contraindications or the patients who do not follow instructions who get into trouble."

The British study was financed by Pfizer Inc., which markets a triptan. It included 63,575 migraine patients, 13,664 of whom were prescribed a triptan.

"There was no association between triptan prescription and stroke or other outcomes studied," the journal report says.

But, ironically, there was a slightly increased risk of stroke in the larger group of patients who were not prescribed a triptan.

"I think that this finding needs further study before it can be interpreted," Hall says.

Socioeconomic factors help explain the finding of an overall lower death rate among triptan users, the researchers say. While migraine is more common in low-income people, patients with higher incomes are more likely to be prescribed the drugs, "and the death rate is lower in those with higher economic status," the report says.

More information

For more on migraines, go to the Cleveland Clinic Foundation or the American Academy of Family Physicians.

SOURCES: Gillian C. Hall, Ph.D, consulting neurologist, Barnet, England; Seymour Diamond, M.D., director, Diamond Headache Clinic, Chicago; February 2004 Neurology
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