She takes sumatriptan 100 mg once daily, occasionally twice, with relief of the headaches within 2 hours. Once or twice per month, the headaches last HSP inhibitor all day, and diclofenac powder either decreases the intensity of the pain or relieves the pain altogether. She was off sumatriptan for 2 weeks without improvement of the headaches. She has hypertension, which is well controlled on lisinopril. A nuclear cardiac stress test was

normal. She does not drink caffeinated beverages. Is there evidence to support the use of daily triptans for chronic, refractory, or intractable migraine? How might you distinguish triptan-overuse headache from chronic migraine? What are the indications for daily or near-daily triptan use? Is there long-term safety information? How does the long-term use of daily triptans compare with chronic opioids or butalbital combinations for intractable migraine? I will start off with the last question comparing daily triptan use with daily use of an opioid or butalbital

combination for the treatment of intractable migraine because I happen to have conducted research on the daily triptan vs daily opioid comparison. The butalbital combinations also contain caffeine, and I will address their daily use vs daily www.selleckchem.com/products/ABT-888.html triptan use when addressing the question about distinguishing triptan-overuse headache from chronic migraine. The research on the daily triptan vs daily opioid comparison I carried out in my headache practice with the help of Kamila Piekos, PharmD.[1] Dr. Piekos contacted by telephone patients who had daily headaches from chronic migraine and were taking a triptan or (long-acting) opioid daily. Daily triptan use was operationally defined as treatment with a triptan for headache

at least 5 days per week. The patients had to have been stable on their (triptan or opioid) headache treatment for at least 4 weeks prior to Thymidylate synthase the interview. Ineligible patients were those who were taking a (long-acting) opioid in addition to a triptan daily, which excluded 3 patients. Two patients in the daily triptan group could not be reached and were consequently also excluded from the study. Information was collected using the Migraine Treatment Satisfaction Questionnaire,[4] Headache Impact Test-6,[5] and a series of additional questions, which included a numerical, 11-point headache pain intensity score. The patients were informed of the purpose of the interview and provided their consent verbally. One patient in each group chose not to participate; these 2 patients were assigned the lowest possible response scores. Statistical significance was assessed using the chi-square test; a P value of .05 or less was considered statistically significant. A total of 53 patients were included in the study, consisting of 28 patients (53%) in the opioid group and 25 patients (47%) in the triptan group (Table 1). The average age of the patients in the opioid and triptan groups were 48.7 ± 7.