A Retrospective Analysis of Triptan and DHE Use for Basilar and Hemiplegic Migraine

Paul G. Mathew, MD, FAHS; Regina Krel, MD; Bhuvin Buddhdev, MD; Hossein Ansari, MD; Shivang G. Joshi, MD, MPH, RPh; Warren D. Spinner, DO; Brad C. Klein, MD, MBA

Disclosures

Headache. 2016;56(5):841-848. 

In This Article

Methods

Four independent retrospective chart reviews were conducted at different institutions. There was no structured questionnaire to identify variables in the same manner at each institution, but the pooled data represent common datasets. Criteria for BM and HM were based on ICHD-II criteria. Some of the patients only had a single recorded basilar aura feature, as noted in Table 3 and Table 11. As such, some of the subjects carried a diagnosis of probable BM. IRB approval was received from each institution, respectively.

A retrospective chart review was conducted at the Brigham & Women's John R. Graham Headache Center (JGHC). All patient visits at the JGHC are recorded in a searchable electronic medical record. A search was conducted using the electronic medical record for patients with a diagnosis of migraine with BM features who had also been prescribed a triptan between 2010–2011.

A retrospective chart review was conducted at Stony Brook University Hospital (SBUH). All patient visits are recorded on a searchable database. A search of patients with the diagnosis BM and HM who were prescribed a triptan from 2007–2013 was conducted.

A retrospective chart review was conducted at the Abington Headache Center and Abington Memorial Hospital. All patient visits are recorded in a searchable electronic medical record. A search was conducted for patients with a diagnosis of migraine with BM or HM features who were also provided intravenous DHE in the outpatient infusion center or inpatient headache unit, respectively, from October 2008 to October 2011. Assessment of adverse events included daily EKG evaluation, vital sign monitoring, physical examination, and patient reported complaints. Prior to intravenous DHE administration, all patients were educated verbally by a physician to report potential side effects including chest pressure or tightness, nausea, shortness of breath, paresthesias, weakness, uncontrollable muscular movements, and restlessness. Adverse events were documented in the electronic medical record. Follow-up visits to assess delayed adverse events occurred after discharge from either outpatient or inpatient unit.

A retrospective chart review was conducted at Neurology and Neuroscience Associates. The search was conducted using electronic medical records and also handwritten patient questionnaires for the patients who had the diagnosis of HM or basilar-type (migraine with brainstem aura) and a prescription for triptan between July 2012 and June 2014.

Search terms included migraine AND basilar, migraine AND hemiplegic, vertigo, tinnitus, hyperacusia, dysarthria, diplopia, hemiplegia/hemiparesis, facial droop, weakness, confusion, altered consciousness, loss of consciousness, confusion, ataxia, and aphasia. Search terms to identify visual or sensory criteria were not utilized by 3 of the 4 sites because such features overlap with those of migraine with more typical forms of aura. The terms utilized for the triptan search in all chart reviews were: sumatriptan (Imitrex), rizatriptan (Maxalt), zolmitriptan (Zomig), eletriptan (Relpax), almotriptan (Axert), frovatriptan (Frova), naratriptan (Amerge), and Treximet. The terms utilized for the DHE search in all chart reviews were: DHE (dihydroergotamine) and DHE 45. After a search identified a potential patient for inclusion, a study author reviewed the chart to confirm the diagnosis, treatment rendered, and whether an adverse event occurred after drug administration prior to the patient's next follow-up appointment. Frequency counts were the only statistical methods utilized in this study.

processing....