European Headache Federation (EHF) consensus on the definition of effective treatment of a migraine attack and of triptan failure
Simona Sacco 1 , Christian Lampl 2 , Faisal Mohammad Amin 3 4 , Mark Braschinsky 5 , Christina Deligianni 3 , Derya Uludüz 6 , Jan Versijpt 7 , Anne Ducros 8 , Raquel Gil-Gouveia 9 10 , Zaza Katsarava 11 12 , Paolo Martelletti 13 , Raffaele Ornello 14 , Bianca Raffaelli 15 , Deirdre M Boucherie 16 , Patricia Pozo-Rosich 17 18 , Margarita Sanchez-Del-Rio 19 , Alexandra Sinclair 20 21 , Antoinette Maassen van den Brink 22 , Uwe Reuter 15 23
Background: Triptans are migraine-specific acute treatments. A well-accepted definition of triptan failure is needed in clinical practice and for research. The primary aim of the present Consensus was to provide a definition of triptan failure. To develop this definition, we deemed necessary to develop as first a consensus definition of effective treatment of an acute migraine attack and of triptan-responder.
Main body: The Consensus process included a preliminary literature review, a Delphi round and a subsequent open discussion. According to the Consensus Panel, effective treatment of a migraine attack is to be defined on patient well-being featured by a) improvement of headache, b) relief of non-pain symptoms and c) absence of adverse events. An attack is considered effectively treated if patient's well-being, as defined above, is restored within 2 hours and for at least 24 hours. An individual with migraine is considered as triptan-responder when the given triptan leads to effective acute attack treatment in at least three out of four migraine attacks. On the other hand, an individual with migraine is considered triptan non-responder in the presence of failure of a single triptan (not matching the definition of triptan-responder). The Consensus Panel defined an individual with migraine as triptan-resistant in the presence of failure of at least 2 triptans; triptan refractory, in the presence of failure to at least 3 triptans, including subcutaneous formulation; triptan ineligibile in the presence of an acknowledged contraindication to triptan use, as specified in the summary of product characteristics.
Conclusions: The novel definitions can be useful in clinical practice for the assessment of acute attack treatments patients with migraine. They may be helpful in identifying people not responding to triptans and in need for novel acute migraine treatments. The definitions will also be of help in standardizing research on migraine acute care.