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Effect of early intervention with almotriptan vs placebo on migraine-associated functional disability: results from the AEGIS Trial. Headache 2008 Mar;48(3):341-54 PMID: 18302700

Pubmed ID

18302700

DOI

10.1111/j.1526-4610.2007.01044.x

Abstract

OBJECTIVE: To investigate the effect of early acute migraine intervention with almotriptan vs placebo on functional disability and health-related quality of life (HRQoL) indicators.

DESIGN/METHODS: In this multicenter, double-blind, parallel-group trial, adults with international classification of headache disorders-defined migraine, with or without aura, were randomized 1:1 to treat 3 consecutive headaches with either almotriptan 12.5 mg or placebo. Patients were instructed to take their study medication at the first sign of migraine headache pain of any intensity, within 1 hour of onset. Patients recorded level of functional disability (normal, disturbed, bed rest required, emergency room [ER]/hospitalization required) at baseline (pretreatment), 0.5, 1, 2, 4, and 24 hours posttreatment and at time of pain-free. Patients completed the Migraine Disability Assessment Scale (MIDAS) at randomization and completed the Migraine Quality-of-Life Questionnaire (MQoL) at 24 hours after each attack.

RESULTS: Results are presented for 315 patients (160 almotriptan, 155 placebo) in the evaluable for efficacy population. At 2 hours posttreatment of Attack 1, 54.4%, 32.5%, 13.1%, and 0%, respectively, of almotriptan-treated patients reported normal function, disturbed function, bed rest required, and ER/hospitalization required compared with 38.1%, 45.2%, 16.1%, and 0.6%, respectively, of placebo-treated patients. The differences in level of functional disability between the 2 treatment groups were statistically significant at 2 hours (P = .007; Cochran-Mantel-Haenszel, stratified by center) and at 4 hours (P < .001). Resolution of pain was associated with a normal level of function; at 2 hours posttreatment, 91.7% of patients in the total population who achieved pain-free reported normal function compared with 44.8%, 8.0%, and 0% of patients with mild, moderate, and severe pain, respectively. The absence compared with the presence of photophobia, phonophobia, and nausea at 2 hours also was associated with less disability (P < .0001 for each symptom). Treatment with almotriptan compared with placebo resulted in consistently better 24-hour MQoL scores with significant results for all 3 migraine headache attacks in the social function and feelings/concern domains. A logistic regression model determined that pretreatment functional level (P = .0117), pretreatment pain intensity (P = .0089), and pretreatment MIDAS score (P = .0152) were significant covariates of the proportion of patients who achieved normal function at 2 hours posttreatment.

CONCLUSIONS: Early treatment with almotriptan within 1 hour of migraine pain onset significantly reduced levels of functional disability at 2 and 4 hours posttreatment compared with placebo. Consistency in improvement of HRQoL indicators was observed across 3 headaches treated.

Author List

Freitag F, Smith T, Mathew N, Rupnow M, Greenberg S, Mao L, Finlayson G, Wright P, Biondi D, AEGIS Investigator Study Group

Author

Frederick G. Freitag DO Associate Professor in the Neurology department at Medical College of Wisconsin




Scopus

2-s2.0-42049099690   21 Citations

MESH terms used to index this publication - Major topics in bold

Adult
Double-Blind Method
Female
Humans
Male
Migraine Disorders
Placebos
Quality of Life
Serotonin Receptor Agonists
Time
Tryptamines
jenkins-FCD Prod-321 98992d628744e349846c2f62ac68f241d7e1ea70