Abstract
We greatly appreciated the interest of Drs. Tfelt-Hansen and Hougaard in reading our evidence-based guidelines for the pharmacological treatment of migraine (1,2). We are grateful for the effort of providing critical feedback to the Guidelines and potentially correcting the data that constitute the source of our recommendations.
Referring to the observations raised by the Authors (3), we carefully reviewed the chapter on Triptans together with the module working group that was responsible for this section. Here are our responses:
- We acknowledge that the study by Dodick et al. (4) was not captured in the final pooled analyses. This has since been addressed. The inclusion of that trial revealed an overall positive result of zolmitriptan 5 mg nasal spray over placebo, which will change the recommendation. - For the study by Charlesworth et al. (5), we confirm that the correct value for 2-h pain relief with zolmitriptan 5 mg nasal spray is 68.9%. As stated above, the recommendation will change for this drug. - We accept the correction referring to the study by Gawel et al. (6). As far as the recalculations are concerned, our estimate might be slightly different from those made by Drs. Tfelt-Hansen and Hougaard given the use of the RevMan software, although with no impact on the overall result. - We agree with the new proposed level of evidence and strength of recommendation for zolmitriptan nasal spray.
Given the transparency and accuracy required by the Guidelines, and starting from the detailed and constructive feedback of Drs. Tfelt-Hansen and Hougaard, we decided not only to review the zolmitriptan sub-section, but all the Triptans section of the Guidelines. We aim at publishing a correction to the Triptans section at the end of our revision.
Footnotes
Declaration of conflicting interests
The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: R.O.: Consulting fees, Allergan-AbbVie, Eli Lilly. Honoraria: Eli Lilly, Novartis, Pfizer, Teva. Support for attending meetings, Allergan-AbbVie, Eli Lilly, Lundbeck, Novartis, Pfizer, Teva. Participating, Allergan-AbbVie, Eli Lilly. Leadership, Jr. Editorial Board member J Headache Pain. Receipt of equipment, Novartis, Eli Lilly. Other financial or non-financial, Eli Lilly, Novartis, Teva.
T.S.M.: Grants from AbbVie, Amgen Site PI: Rehaler, AbbVie, Ipsen, Eli Lilly. Consulting fees, Pfizer,AbbVie, Merz. Honoraria, Medscape, American Headache Society, American Academy of Neurology. Novartis, Massachusetts Medical Society. Advisory boards, Teva, Pfizer, AbbVie, eNeura, LinPharma. Leadership: IHS Board of Trustee, Florida Society of Neurology, American Headache Society, American Academy of Neurology, American Neurological Association, Editorial Boards: Cephalalgia, Neurology, Brain and Life Magazine, American Migraine Foundation, Continuum Audio.
A.R.: Honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events (in the past 36 months) from Ely-Lilly, AbbVie, Teva Pharmaceuticals, Pfizer. Support for attending meetings and/ or travel (past 36 months) from Ely-Lilly, AbbVie, Teva Pharmaceuticals, Pfizer Lundbeck. Participation on a Data Safety Monitoring Board or Advisory Board (past 36 months) from Ely-Lilly, AbbVie, Teva Pharmaceuticals, Pfizer. Specialty Chief Editor for Headache and Neurogenic Pain Frontiers in Neurology. Member of executive board of the Italian Headache Society (S.I.S.C.).
M.S.: Speaker honoraria from Novartis, Pfizer, Allergan, Teva and Lilly.
S.S.: For this manuscript, Novartis, Uriach. Royalties, Abbott, Allergan-AbbVie, AstraZeneca, Boheringer, Eli Lilly, Lundbeck, Novartis, NovoNordisk, Pfizer, Teva. Consulting fees, Abbott, Allergan-AbbVie, AstraZeneca, Boheringer, Eli Lilly, Lundbeck, MedScape, Novartis, NovoNordisk, Pfizer, Teva. Expert testimony, Abbott, Allergan-AbbVie, AstraZeneca, Boheringer, Eli Lilly, Lundbeck, Novartis, NovoNordisk, Pfizer, Teva, Bayer, Medtronic, Starmed, Bristol-Myers-Squibb, Daiichi-Sankyo. Patents, Allergan-AbbVie, AstraZeneca, Eli Lilly, Lundbeck, Novartis, Pfizer, Teva. Leadership, President-elect European Stroke Organization, Editor-in-Chief Cephalalgia and Cephalalgia Reports, assistant editor for Stroke.
I.O., A.T., and K.N.G. declare no conflict of interest.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
