Triptans and Serotonin Syndrome
On July 19th, 2006 the FDA published a report that Triptans should be used with caution with SSRI (newer anti-depressants) because a risk of having too much brain serotonin. Since then pharmacies have been giving warning to patients not to mix the two classes of drugs.
The American Headache Society regrets this decision by the FDA as there was no supporting evidence of such risks. The recent study looked at prescribing habits of medical providers since the release of the FDA warning. Those who know the most about triptans, neurologists and headache specialists, did not alter their behavior because of our confidence in the medications. Primary care providers did stop prescribing the two classes of medications together.
A review of the cases still does not support the over-alarm of combining these medications. It is unfortunate that many patients who can benefit from triptans are being denied them because of the FDA warning.
Randomized, Controlled Study of Telcagepant in Patients With Migraine and Coronary Artery Disease.
You will probably be hearing a lot about telcagepant in the coming years. It is the first of a whole new class of medications that abort (stop in their tracks) migraines. What is unique about this class is that they do not constrict blood vessels. That is one of the problems with the triptans (sumaptriptan or Imitrex) class. So we don’t like to use the triptans in patients with blood vessel problems, including heart disease. This creates a real quandary for patients who have severe migraines and heart or blood vessel disease.
This study showed no bad adverse reactions in patient with heard disease.
The Recent Issue of Headache Currents Reviewed Pediatric Headaches in Five Articles
In summary, what we are learning about children with headaches is that they are typical of the same type adults get, but their treatment is poorer. Some of the major reasons children are not treated well is that their parents want to avoid medical treatment at all cost, fearing that medical treatment would be harmful. Many parents, especially if none of them have headaches, assume that the children’s headaches are caused by needing glasses, sinus issues, playing too many video games and etc. The parents prefer treatment with natural products, such as vitamins. There are some limited studies that butterbur, riboflavin, magnesium and Co Enzyme Q 10 may be helpful. However, many children suffer far longer than they should when these things fail and it is time to consider prescription medication.