A retrospective study showed that triptans and dihydroergotamine (DHE) were used for the abortive treatment of migraines with basilar and hemiplegic-type features, with no reported, subsequent acute/subacute ischemic vascular events. Study findings are published inHeadache

Triptans and DHE currently hold a black box warning for two migraine subtypes (basilar migraine [BM] and hemiplegic migraine [HM]) due to the risk of stroke. Researchers from Abinton-Jefferson Health conducted a retrospective chart review to demonstrate that off-label use of triptans and DHE could be used for BM and HM without significant adverse ischemic vascular events. 

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They evaluated patients with BM or HM features who received acute abortive treatment with either triptans or DHE across four headache centers to assess the frequency of ischemic vascular events after receiving the medication. A total of 67 patients with BM features and 13 patients with HM features were included for the study. Forty patients in the BM group and 5 in the HM group received triptans; 27 in the BM group and eight in the HM group received DHE. 

No incidence of stroke or myocardial infarction were reported during the period of routine follow-up, according to senior author Brad Klein, MD. Some patients in the triptan arm reported gastrointestinal (GI) upset, rash, neck, dystonia, nightmares, and flushing. Some patients in the DHE group reported chest tightness, dystonic reaction, transient asymptomatic anterior T wave inversion, and agitation. 

Small sample sizes produced theoretical statistical adverse event rates of 4.5% (BM) and 23% (HM) but Dr. Klein concluded that “there has been no clear evidence that BM and HM carry an actual elevated risk for vascular events compared with migraine with aura.” He added that this review included the largest patient cohort to date and was also one of the first to evaluate patients treated with DHE

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