REPORT FROM THE 67TH AMERICAN ACADEMY OF NEUROLOGY (AAN) ANNUAL MEETING – WASHINGTON DC, APRIL 18-25, 2015 – The TARGET trial evaluated low-dose sumatriptan powder delivered intranasally using a breath-powered device (AVP-825) in patients with acute migraine (McAllister et al. AAN 2015; abstract P1.300; full results published as Cady et al. Headache 2015;55:88-100).

A total of 223 subjects with acute migraine were randomized to intranasal sumatriptan 22 mg or placebo. A treatment effect was evident within 15 minutes, reached statistical significance at 30 minutes post-dose (42% vs. 27% with headache relief). The effect was sustained at 24 hours (44% vs. 24%) and 48 hours (34% vs. 20%). One-third were pain-free at two hours post-dose with active treatment compared to 17% with placebo. The proportion achieving meaningful pain relief at two hours was 70% with intranasal sumatriptan versus 45% with placebo, according to patient self-rating. Fewer patients on active treatment required rescue medications (37% vs 52%). One patient receiving intranasal sumatriptan reported mild paresthesia. No serious adverse events were reported.

An intranasal formulation of zolmitriptan is also available. A UK study found that patients have a similar preference for intranasal administration and fast-dissolving tablets, in large part because of speed of onset (Dowson et al. Headache 2007;47:1144-1151).

Guest Reviewer: Dr. Daniel Selchen, Head of Neurology, St. Michael’s Hospital, Toronto, Canada