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Prolonged migraine auras and Triptans

I just had a WTF moment as I randomly was looking at information for something else. Sometimes you hit something and it just knocks you upside the head. In this case because I have had permanent nerve damage in my hand I was told was caused by the viscous status migraine I had, as it occurred during it, but that it has happened because of the status migraine and the fact I always have as it were this pre-migraine state... the persistent migraine auras. Another neuro said, well, it was likely a stroke in your sleep, which then caused the nerve damage. Either way, nerve damage from migraine. Sucks, but there you go.


But... then this wee tidbit. it turns out that triptans and ergotamines are contradicted for treatment in prolonged auras, just as they are for HM and basilar migraines and for the same reason... an increase in stroke risk. Advanced Therapy of Headache Book It Is a good place to find a reference for what I was talking about.

Third, triptans probably do not work for aura,
and may in fact be contraindicated in prolonged aura.
Three randomized controlled trials found administra-
tion of triptans during aura did not terminate aura or
prevent the migraine which followed the aura, using
sumatriptan 6 mg subcutaneous, zolmitriptan oral
20 mg, and eletriptan.
4-6
However, 1 small controlled
study with oral sumatriptan 100 mg reported success
in preventing the migraine in 34/38 (89%) of auras
treated.
7
These 4 trials show triptans do not work to elimi-
nate aura. Use of a triptan to try to clear a persistent
aura is not evidence-based, and is bound for failure.
The question as to whether a vasoconstrictive agent
might be harmful for a patient with a fresh infarction
is another concern.
Clinical pearl: don’t use triptans
during aura or for persistent aura. (TEACHING CASE: MIGRAINE STROKE)
Juan Gonzalez, MD
Chief Resident in Neurology, Dartmouth Hitch-
cock Medical Center

Over and over I have read it is contradicted and not to be used. In one article I read it said some headache specialists might use them 'with caution' and supervision' and I would assume... if their patient had nerve damage or a stroke, they might reconsider that. One would think.

This would have been nice to know since I have had a persistent migraine aura for decades and have been on triptans since I was diagnosed. And for a while there even estrogen birth control. And that I actually had nerve damage from a status migraine, which is very odd indeed, blamed on the my prolonged auras and the status migraine, or as the other neuro asserts I must have had a stroke.

And knowing this as they did... I am Still on triptans. Even though clearly that could be a freaking factor. I think the neuros treaking me are not aware of this risk at all. Or simply did not find it to be a valid risk. But can we pick and choose risks when migraine with aura comes with more stroke risk already? I mean the birth control with estrogen is an absolute no now... so what about this one? No, but maybe, depends on whether your neuro likes triptans and has a stigma against other treatments?

Or they read this very small study with 13 participants, which meant maybe one or two had persistent migraine auras.:

Triptans in the treatment of basilar migraine and migraine with prolonged aura.

Colorado Neurology and Headache Center, Denver, CO 80218, USA.

 OBJECTIVE:To report on the use of triptans in migraine with prominent neurologic symptoms.

BACKGROUND:

As stated in their package inserts, the triptans are contraindicated in patients with basilar or familial hemiplegic migraine, and physicians are reluctant to prescribe these drugs to other patients with prominent or prolonged aura.

METHODS:

We evaluated 13 patients with basilar migraine, familial hemiplegic migraine, or migraine with prominent or prolonged aura who had received triptans.

RESULTS:

Excellent; no adverse events.

CONCLUSION:

The contraindication of triptans in basilar migraine should be reconsidered. Similarly, prominent or prolonged aura may not represent a reasonable contraindication to triptan therapy.
Well I don't feel very comforted on that one thank you very much. Your very small study of 13 individuals does little to assure me there are not complications that can occur in All of those, even if it was 13 of Each, and it wasn't. I think you might want to research that a little bit more. So I think they should 'reconsider' that a whole lot more. I have known people who have had strokes from changing triptans. Known people who had strokes from trying triptans. So if a person has a contradiction based on type of migraine or prolonged auras... I take that seriously.

Also... migraine with auras are contradicted with use with beta blockers. Same reason. And before I had asthma... I had tried out two beta blockers that I remember. So clearly that was Also not something that was considered, even though That one was not something that was waffled on... it was a do not put them on beta blockers thing.

Sort of freaky that I was not aware of this. And sort of freaky I don't think all the neuros I have seen are aware of this.
 
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