Taşkın DUMAN, Hava Özlem DEDE, Gülşah ŞEYDAOĞLU

Migren atak tedavisinde triptan, NSAİİ ve kombinasyon tedavisinin karşılaştırması

Amaç: Migren atağında baş ağrısı aynı atak içinde rekürrens gösterebilmektedir. Çalışmamızın amacı migren atağını sonlandırmak için yaygın kullanılan nonsteroid antienflamatuvar ilaçlar (NSAİİ) ve triptan gruplarından seçilen birer ajanın ve bunların kombine kullanımının migren atağını sonlandırma üzerindeki etkilerini göstermek ve karşılaştırmaktır.Gereç ve Yöntem: Altmış yedi migren hastasına ait 201 atak değerlendirildi. Hastalar sıra ile üç ayrı tedavi grubuna bire birer alındılar. Birinci grup hastanın baş ağrısı atağı başladığında rizatriptan 10 mg, ikinci grubun tenoksikam 20 mg, üçüncü grubun rizatriptan 10 mg ve ek olarak tenoksikam 20 mg alması sağlandı. Hastalar ağrıyı hissettikleri ve ilaçlarını aldıkları anda, 30 dakika, 60 dakika, bir saat, iki saat, dört saat, sekiz saat sonra ve ertesi gündeki baş ağrısı şiddetlerini Vizüel Analog Skalası'nda (VAS) işaretlediler. Her hasta için toplam üç ayrı atak değerlendirildi. Ataklar, her tedavi alternatifi için ayrı ayrı değerlendirilerek karşılaştırıldı.Bulgular: Tedavi gruplarının VAS değerleri atak başlangıcında farksız iken, Rizatriptan grubunda ve kombinasyon grubunda 30. dakikadan itibaren VAS puanları tenoksikama göre daha düşük bulundu. Rizatriptan grubunda ve kombinasyon grubunda 60. dakikada VAS ortalama değeri 4'ün altına düştü. Tenoksikam grubunda ise 60. dakika VAS değeri dördün üzerinde kaldı ve bu gruptaki VAS ortalaması hem rizatriptan hem de kombinasyon grubundan anlamlı olarak daha yüksek bulundu. Yirmi dördüncü saat değerlendirmesinde ise kombinasyon ve tenoksikam gruplarının VAS puanları birbirine eşi, rizatriptan grubunun VAS ortalaması diğer iki gruptan yüksek bulundu.Sonuç: Tek ilaç ile yeterli kontrol sağlanamayan ataklarda hızlı etkili triptan ve uzun etkili NSAİİ uygun bir tedavi seçeneği olarak görünmektedir.

Comparison of triptans, NSAID and combination in migraine attack treatment

Objectives: Headache during migraine attack may recur during a single attack. The present study evaluated efficacy of both individual and combined use of agents from nonsteroidal anti-inflammatory drug (NSAID) and triptan groups widely used in treatment of migraine attacks.Methods: A total of 201 attacks in 67 migraine patients were evaluated. Patients were divided into 3 study groups: those receiving rizatriptan 10mg, tenoxicam 20 mg, and rizatriptan + tenoxicam (combination). Patients evaluated severity of headache based on visual analogue scale (VAS) at moment of drug delivery, after 30 minutes, and after 1, 2, 4, 8 and 24 hours. Attacks were evaluated separately for each treatment alternative, and results were also compared.Results: VAS values were the same at onset of attack, but were lower in rizatriptan and combination groups than in tenoxicam group at 30 minutes and onward. VAS score was above 4 at 60 minutes in tenoxicam group and mean VAS value in this group was found to be significantly higher than values in rizatriptan and combined groups. At 24 hours, VAS scores were similar in combination and tenoxicam groups, while rizatriptan group had higher mean VAS score than the other 2 groups.Conclusion: When single drug use fails to provide adequate control, combined use of a rapid-acting triptan and a long-acting NSAID appears to be a suitable treatment option.

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