Two patients with known aspartame-triggered and rizatriptan-responsive migraine had their headaches worsened following use of an aspartame-containing formulation of rizatriptan (Maxalt-MLT), in a report from Albert Einstein College of Medicine, Bronx, NY. A 14-year-old boy with a 2 year history of migraine with aura was tested with an elimination diet and found to have attacks triggered by aspartame-containing foods and drinks. On at least 20 occasions, these attacks were rapidly aborted by treatment with triptans, including an oral preparation of rizatriptan. The headaches worsened and persisted for six hours when rizatriptan oral wafers were substituted for the aspartame-free tablets. A 36-year-old woman with a 30-year history of migraine without aura had headaches consistently triggered by aspartame-containing foods, monosodium glutamate, and nitrites. On 15 occasions, headaches were relieved within 45 minutes by treatment with oral rizatriptan. Following substitution of the aspartame-containing wafer form of rizatriptan, the migraine attack steadily worsened and lasted 6 hours. In both patients, further attacks were aborted by aspartame-free tablets of rizatriptan. Neither patient would agree to a rechallenge with the wafer formulation. [1]

COMMENT. Despite the small amount of aspartame (3.75 mg) in the 10 mg wafer of rizatriptan, aspartame is a probable migraine-trigger in these two patients with known aspartame sensitivity. In two of three double-blind, randomized, placebo-controlled studies, cited by the authors, headaches were more frequent during aspartame treatment.

Egger J, Wilson J and associates at the Hospital for Sick Children, London, have previously demonstrated the importance of some foods as precipitants of migraine in children and the value of an “oligoantigenic” elimination diet in treatment. Food items found to trigger headache include cow milk, orange juice, wheat, eggs, tomato, pork, and chocolate [2, 3]. See Progress in Pediatric Neurology I and III, PNB Publ, 1991 and 1997, for reference to diet including aspartame as a migraine trigger.