frova

Frovatriptan (Frova or Migard) is one of the targeted migraine abortive drugs known commonly as triptans.  But not all triptans are created equal.

Many of you know that you can have success with one triptan even after you’ve tried others.  Recently, frovatriptan has emerged as one of the most recommended abortives for migraine.  So let’s take a closer look…

Frovatriptan (frovatriptan succinate) is a selective 5-hydroxy-tryptamine1 (5-HT1B/1D) receptor subtype agonist.  Triptan medications were developed for migraine because of the way they influenced blood vessels, although now we know that they probably fight migraine for other reasons (read more about triptans and migraine here).

Although many think of frovatriptan as a "painkiller", it’s not just a general pain reliever.  It’s not prescribed for any pain, but specifically to fight migraine – and not just the pain that often comes with migraine, other symptoms as well.

For example, Frova may fight sensitivity to light and noise, and nausea/vomiting.

Where does frovatriptan excel?

One of the reasons that frovatriptan has become one of the most recommended triptans is because it’s been found to be useful in preventing or treating menstrual migraine (perimenstrual migraine).  Since menstrually related migraine affects up to 60% of female migraineurs, that’s a significant chunk of the migraineur population!

Although other triptans work well too, frovatriptan seems to come with a significant advantage.  The effects tend to last longer.

That means that there’s less chance of the symptoms coming back.  (For example, a study showed that symptoms were 8% more likely to return with frovatriptan, and 21% with almotriptan.  Another study compared rizatriptan, zolmitriptan and almotriptan, finding that symptoms were almost twice as likely to return in 24 and 48 hours with these than with frovatriptan).

This is especially important in menstrual migraine, where symptoms do tend to last longer and are more likely to return.

Of course, frovatriptan is not just beneficial for menstrual migraine.  For example, this study shows benefits for patients with migraine with aura.

For side effects, frovatriptan seems less likely to cause nausea than some other triptans.

Frovatriptan is often taken per-emptively for menstrual migraine.  It’s been compared favourably with preventative topiramate (Topamax) for monthly migraine attacks.

Where does frovatriptan fall short?

Frovatriptan is not necessarily worse than other triptans, just different, which is why it’s important not to give up after trying just one triptan.

Common side effects with frovatriptan include dizziness, headache and tiredness.  Other triptans may cause the same side effects, but again trying another triptan may solve the problem for you.

Cautions

Be sure to check with a doctor who knows your medical history before taking this medication.  This is particularly important if you you are taking an SSRI (selective serotonin reuptake inhibitor) or SNRI antidepressant drug (serotonin-norepinephrine reuptake inhibitor).  Also, make sure your doctor knows if you’ve had issues with heart disease, or if you’re at high risk.

Contraceptive drugs can also interact with frovatriptan specifically and increase side effects – talk to your doctor.

Other medications may interact as well, such as ergotamine medications and propranolol.

How do I take Frovatriptan?

The basic dosage recommendations are similar but different in the USA, Canada, and the UK, so here they are.  Remember, these are general guidelines – follow your doctor’s instructions!

Take a 2.5 milligram dose as soon as possible when the symptoms begin.  In the USA, the recommendation is to take a second dose after 2 hours, but take no more than 7.5 milligrams in 24 hours.

In Canada and the UK, the recommendation is to take a second dose after 4 hours, but no more than 5 milligrams in 24 hours.

If you experience side effects, or if your symptoms change, or if you’re having to treat more than 2 or 3 attacks per month, talk to your doctor right away.  Frovatriptan is not intended for constant usage, and can lead to even more migraine symptoms and other worse conditions.

For more information, see Frovatriptan (Oral Route) (Mayo Clinic), Frovatriptan (Patient.co.uk), and The Pill Book (2012 edition).