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


Headache. 2016;56(5):841-848. 

In This Article


In this retrospective, multicenter study, triptans and DHE were used without any subsequent acute/subacute ischemic vascular events for the abortive treatment of migraines with basilar and hemiplegic type features.

The absence of significant adverse events with triptan use in migraine patients with basilar features adds to the data that suggest that significant basilar artery vasoconstriction may not be part of the pathophysiology of BM. As such, the renaming of BM in the ICHD-3-beta version to migraine with brainstem aura is better in that the name no longer implies basilar artery vasoconstriction. Although the brain stem likely plays a role in the pathophysiology of migraine,[12] it is unclear whether the symptoms specific to BM actually originate from the brain stem, and future studies may better delinate this point.

There has been no clear evidence that HM carries an actual elevated risk of stroke compared with migraine with aura. A lack of significant vasoconstriction during the aura phase of BM and HM may make the use of triptans or DHE potentially safe.

Although the small sample sizes generated theoretical statistical event rates of 4.5% for BM and 23% for HM, these data suggest that further justification is warranted regarding the black box warning for the use of triptans in both BM and HM.