Clinical records and
headache calendars were reviewed of 27 patients fulfilling the following inclusion criteria: (1) aged 18 to 65 years; (2) diagnosis of chronic
migraine (formerly transformed
migraine), according to the criteria proposed by Silberstein et al; (3) previous failure of at least 4 preventive medications prescribed as part of a management program that included nonpharmacological measures, preventive medication, acute care medication, and detoxification from overused medication; and (4) have used daily
naratriptan for no less than 2 consecutive months. The dose of
naratriptan prescribed was 2.5 mg twice daily. We considered the following outcomes: (1) frequency of
headache, (2) intensity of
pain, (3) number of days per month with severe
headache, (4)
headache index (frequency times intensity), and (5) proportion of patients who reverted to an episodic pattern of
pain after 6 months of treatment.
RESULTS: There was a statistically significant reduction in the frequency of
headache days 2 months (15.3 days versus 24.1 days at baseline, P<.001), 6 months (9.1 days, P<.001), and 1 year (7.3 days, P<.001) after daily treatment with
naratriptan was initiated. There was also a statistically significant reduction in the number of days per month of severe
pain at 1 month (5.6 days versus 12.5 days at baseline, P<.01), 2 months (5.7 days, P<.01), 6 months (2.8 days, P<.01), and 1 year (2.6 days, P<.01). Similarly, there was a statistically significant reduction in the
headache index at 2 months (33 versus 56.4 at baseline, P<.001), 6 months (19.5, P<.001), and 1 year (17.2, P<.001). Of the 20 patients who continued to use
naratriptan daily for at least 6 months, 13 (65%) reverted to an episodic pattern of
pain (
migraine). At 1 year, 11 (55%) still continued to experience episodic
headache, 1 (5%) relapsed to chronic
migraine, and 2 (10%) were lost to follow-up. No patients had intolerability to
naratriptan during the treatment period, and no one stopped treatment due to adverse events.
CONCLUSIONS: