The incidence of stroke, cardiovascular events, and death among 63,575 patients with migraine was compared in those prescribed a triptan (13,664, 21.5%), non-triptan-treated, and matched nonmigraine control subjects (77,239) identified from the General Practice Research Database by researchers at the Institute of Neurology, University College, London, UK, and Pfizer Inc, New York, NY. The mean observation periods were 35.6 months for migraine patients and 33.3 months for controls. Mean number of triptan prescriptions was 8.6 (range 1-316). Ergotamine treatment was also used in 582 (4.3%) of triptan-treated and 1,598 (3.2%) of non-triptan-treated group. Triptans (at least 3 prescriptions) were not associated with an increased risk of stroke, serious cardiovascular events, or death in this cohort of men and women patients between 15 and 60+ years. A small increased risk of stroke occurred in migraineurs not treated with triptan. The association between migraine and stroke decreased with increasing age at stroke. An association with migraine and stroke was observed across all age and sex groups, with the strongest associations in men aged 45 to 59 years and women of child-bearing age. Triptans were prescribed to those less at risk of stroke and myocardial infarction. [1]

COMMENT. Migraine is a rare precipitant of acute ischemic stroke, mostly occurring in young women in association with attacks of migraine with aura (see Progress in Pediatric Neurology III, PNB Publishers, 1997; 174-5). Triptans constrict coronary arteries, and triptan-induced chest pain may mimic angina. Triptans are contraindicated in patients with ischemic heart disease, and some uncontrolled reports of triptan-associated stroke have limited their use in some cases of migraine. The above controlled study has shown that in general practice, triptan treatment in migraine does not increase the risk of stroke, as long as the treatment is used in patients less at risk of stroke. A slightly higher risk of stroke in the non-triptan-treated group with migraine is noteworthy. The safety and efficacy of triptans has not been established for use in children (PDR 2003).